Trepidation in applying for the NHSC scholarship

[chopped1989]

Hi all,

I was recently accepted to med school (Class of 2016!) and was contemplating applying for this scholarship. I will be attending a private med school and COA will be around $70-75K per year. That will put me about $300 K in debt not including loans I have from my other grad degree (around $30 K). Since I applied to med school, I have been thinking about going into Internal Medicine, with possibly specializing in endocrinology, nephrology or geriatrics. I come from a disadvantaged background and do want to serve communities in need. But, I am afraid that coming out of med school with so much debt will force me to choose something more lucrative. Eventually I would like to be in academia or the government doing research on health disparities or something public health related and of course, practicing...preferably in a low income community.

I have been doing research on the NHSC on SDN and it seems that a lot of the current scholars don't recommend it because it offers little flexibility in terms on job locations, low pay, etc. I wouldn't mind spending four years in any part of the country really...as long as the people there aren't racist. Also, I worry about having a SO...I am currently single but I do eventually want to have a family. Any advice on this?

My other concern in doing a fellowship after completing my commitment. Will it be difficult to get a fellowship four years after completing residency versus coming fresh out of residency. Also, will it diminish my prospects of going into academia or the government?

In terms of age, I will be 26 when I finish med school, 29 when I finish an IM residency, and probably 33 when I finish my commitment.

I was all for applying before I read the other posts on SDN. I called up the NHSC scholarship and the application opens up tomorrow. I am debating on whether to apply this year. Or should I wait until I have had a year under of med school under my belt?

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[smq123]

Hi all,

I was recently accepted to med school (Class of 2016!) and was contemplating applying for this scholarship.

First of all, congratulations on your acceptance.

Since I applied to med school, I have been thinking about going into Internal Medicine, with possibly specializing in endocrinology, nephrology or geriatrics. I come from a disadvantaged background and do want to serve communities in need. But, I am afraid that coming out of med school with so much debt will force me to choose something more lucrative. Eventually I would like to be in academia or the government doing research on health disparities or something public health related and of course, practicing...preferably in a low income community.

Well, you could still specialize in geriatrics, even from Internal Medicine. While most people entering into a geriatrics fellowship do so from Family Medicine, you could probably successfully petition to do a geriatrics fellowship out of Internal.

I will say, I don't know how successfully you could balance a career in Public Health academia/research and a robust clinical practice. People tend to do one or the other; few manage to do both to a meaningful degree. Particularly in a low income community. I guess you could volunteer in a free clinic, but that's not terribly common.

I have been doing research on the NHSC on SDN and it seems that a lot of the current scholars don't recommend it because it offers little flexibility in terms on job locations, low pay, etc. I wouldn't mind spending four years in any part of the country really...as long as the people there aren't racist. Also, I worry about having a SO...I am currently single but I do eventually want to have a family. Any advice on this?

It definitely does offer less flexibility in terms of job locations. If you're ok with living somewhere fairly rural, or outside of big popular cities (like LA or SF), then you might also be ok. If you insist on living in LA, Miami, or inside the Boston-NYC-Philly corridor, you will have much more trouble. (For some reason, finding a job in DC and Baltimore was not that difficult this year.)

Your options will also depend on what you want to do. You will have the most ease finding a job in a location you want if you are in Family Med, less ease if you are in Internal Medicine, Peds, or Psych, and the least ease if you are in OB/gyn.

As far as your concern about racism, don't fall into believing that certain parts of the country are stereotypically more racist than others. I have lived almost all of my life in the NYC-Philly-DC area, and have heard some of the most unintentionally racist and hurtful things here...despite the fact that this area is considered one of the more "liberal" places in the country. I went to med school in Philly, and heard a patient in the ER tell the nurse to "get the janitor out of here!" - pointing his finger at the African American chief surgical resident.

Also, I worry about having a SO...I am currently single but I do eventually want to have a family. Any advice on this?

You can have a family. There's nothing inherent in the NHSC scholarship that precludes that. The hard part is if you get married to someone who is very geographically limited...that could limit where you could get a job when you pay back your NHSC obligation. If your spouse is more flexible, that helps.

My other concern in doing a fellowship after completing my commitment. Will it be difficult to get a fellowship four years after completing residency versus coming fresh out of residency. Also, will it diminish my prospects of going into academia or the government?

Whether or not you can get a fellowship after your 4 year commitment depends on which fellowship. A very competitive one such as GI or cardiology may be difficult. Endocrine or nephrology are not terribly competitive, and it might not be as hard. It all depends.

As far as getting into academia or the government...you have to understand, most physicians do NOT want to go into academia or the government. Academic jobs and federal jobs have more rules, more paperwork, and the pay is significantly less than what you could make in private practice. I mean...it can be almost jaw-droppingly less. So the competition to get into academic or government jobs is not nearly as stiff as you seem to think it is.

Anyway, maybe you'll be the next Dr. Regina Benjamin. Dr. Benjamin was an NHSC scholar, and is the current Surgeon General.

[YOUTUBE]HLnVq2EdX-s[/YOUTUBE]

I am debating on whether to apply this year. Or should I wait until I have had a year under of med school under my belt?

There is no harm in applying now. If you get the scholarship, but are still unsure, you can always decline.

I understand...the money is very tempting and the debt is very scary. But, as you said, it's a serious decision that requires some time to think about. But there's no downside to applying now. You might not even get it this year, and then your decision is made.

 

[chopped1989]

First of all, congratulations on your acceptance.



Well, you could still specialize in geriatrics, even from Internal Medicine. While most people entering into a geriatrics fellowship do so from Family Medicine, you could probably successfully petition to do a geriatrics fellowship out of Internal.

I will say, I don't know how successfully you could balance a career in Public Health academia/research and a robust clinical practice. People tend to do one or the other; few manage to do both to a meaningful degree. Particularly in a low income community. I guess you could volunteer in a free clinic, but that's not terribly common.



It definitely does offer less flexibility in terms of job locations. If you're ok with living somewhere fairly rural, or outside of big popular cities (like LA or SF), then you might also be ok. If you insist on living in LA, Miami, or inside the Boston-NYC-Philly corridor, you will have much more trouble. (For some reason, finding a job in DC and Baltimore was not that difficult this year.)

Your options will also depend on what you want to do. You will have the most ease finding a job in a location you want if you are in Family Med, less ease if you are in Internal Medicine, Peds, or Psych, and the least ease if you are in OB/gyn.

As far as your concern about racism, don't fall into believing that certain parts of the country are stereotypically more racist than others. I have lived almost all of my life in the NYC-Philly-DC area, and have heard some of the most unintentionally racist and hurtful things here...despite the fact that this area is considered one of the more "liberal" places in the country. I went to med school in Philly, and heard a patient in the ER tell the nurse to "get the janitor out of here!" - pointing his finger at the African American chief surgical resident.



You can have a family. There's nothing inherent in the NHSC scholarship that precludes that. The hard part is if you get married to someone who is very geographically limited...that could limit where you could get a job when you pay back your NHSC obligation. If your spouse is more flexible, that helps.



Whether or not you can get a fellowship after your 4 year commitment depends on which fellowship. A very competitive one such as GI or cardiology may be difficult. Endocrine or nephrology are not terribly competitive, and it might not be as hard. It all depends.

As far as getting into academia or the government...you have to understand, most physicians do NOT want to go into academia or the government. Academic jobs and federal jobs have more rules, more paperwork, and the pay is significantly less than what you could make in private practice. I mean...it can be almost jaw-droppingly less. So the competition to get into academic or government jobs is not nearly as stiff as you seem to think it is.

Anyway, maybe you'll be the next Dr. Regina Benjamin. Dr. Benjamin was an NHSC scholar, and is the current Surgeon General.

[YOUTUBE]HLnVq2EdX-s[/YOUTUBE]



There is no harm in applying now. If you get the scholarship, but are still unsure, you can always decline.

I understand...the money is very tempting and the debt is very scary. But, as you said, it's a serious decision that requires some time to think about. But there's no downside to applying now. You might not even get it this year, and then your decision is made.

Thanks a lot for the detailed reply. I think I will go ahead and apply and see where it takes me

 

[montessori2md]

I would be SURE you only want to specialize in one of the possible specialties before you apply. You can always apply next year for a 3 year scholarship. It would be unfortunate for you to fall in love with neurology, PM&R, a surgical field, etc, but to be locked into the commitment. Agree w/ SMQ regarding fellowship. As long as you're not trying for something uber competitive, you'll be able to sub-specialize later if you like. You may even get help in a rural area if they need that specialty.
The scholarship is designed for students who want to do primary care in an underserved community, either because it is rural or urban poor. If that's you, then it's a no-brainer. If that's not you...well, you have some thinking to do, especially regarding the specialty.
If you're interested in academic/gov't work down the road, especially policy/global health, the scholarship will open doors for you, not close them. If you want to do academic/gov't work as in work on drug development/ FDA, etc, it may be a little more difficult to use it as a launchpad, but I think you could still get some leverage out of it.

 

[Leonardsean]

I'm a second year medical student (Class of 2015) and am Dead set and Hell Bent on becoming a psychiatrist. The NHSC program allows Psychiatry as a "primary care" specialty.

My only concern is that the materials seem a little vague about the geography of the eventual service. How much control do applicants have to consider where they serve? I've checked the job opportunities listing and they have positions available in and around my home town...

But I just fear having to uproot my family on some NHSC whim and have to move to say, Alaska (what was that show? Northern Exposure?).

Any insight would be appreciated.

Thanks,

--Sean

 

[smq123]

I'm a second year medical student (Class of 2015) and am Dead set and Hell Bent on becoming a psychiatrist. The NHSC program allows Psychiatry as a "primary care" specialty.

My only concern is that the materials seem a little vague about the geography of the eventual service. How much control do applicants have to consider where they serve? I've checked the job opportunities listing and they have positions available in and around my home town...

But I just fear having to uproot my family on some NHSC whim and have to move to say, Alaska (what was that show? Northern Exposure?).

Any insight would be appreciated.

Thanks,

--Sean

I wrote a thread about my job search experience: http://forums.studentdoctor.net/showthread.php?t=864767.

I would say that you have SOME control over where you end up. As long as your site meets the score requirements and the NHSC approves them as a site, you're fine. You are at the whim of how much demand your field has, and where you want to go. Finding an NHSC job in NYC or Philly was impossible last year, but it didn't mean that you necessarily had to end up in Alaska, either.