Why I didn't take hpsp (for those interested in the scholarship)

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theonlytycrane

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Just a thread for people who may be considering HPSP in the future. I didn't take HPSP because I wasn't confident that I would receive the best medical training through military residency and/or staff physician assignments post-residency. Some staff physician assignments are probably great, but some may be less than ideal in terms of case load/volume and may result in skill atrophy. Ultimately this is what drove my decision, forgetting about the money/service/adventure.

Other cons for me were: less residency spots per speciality, training interruption via GMO, less pay post-residency for most specialties, and a probably a few others I can't remember.

I was okay with deployment, adventure, taking orders, challenges (both mental and physical), and danger. But feeling like I wouldn't receive the best training possible later on made me realize that I would rather take debt while pursuing the path that I want than be debt-free, but not continuing to develop my skills as a doctor in the way that I want.

The last thing I'll say is that the money is super front-loaded in looking nice with the 20k bonus, monthly stipend, and tuition. But if you look far ahead to post-residency and 4 years of active duty service, it ends up balancing out or even being less for most specialties. The money only may make sense if you want to go primary care.

Everything I just said has been already mentioned on these forums, I just wanted to share my thoughts for anyone interested in HPSP for the upcoming cycle(s). It really comes down to whether you want to serve the country above all else and be happy doing that. Thanks to everyone @psychbender @Homunculus @pgg @WernickeDO @Gastrapathy @HighPriest who provided me with insight over the last few months (I probably forgot a few, but you know who you are). Without this group, I probably would have blindly commissioned a month ago, only to slowly learn everything above in the years to come.

Thank you for your service to the brave docs who are still serving or who have served and I hope this thread helps people in the future :)

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Great! If you want the best possible training and get paid based on productivity then you made right choice to stay out of military. I have few more years to go before retirement and it really sucks that I have little control over many things such as pay, location. Bottom line is Army does not look after your best interest and have no problem sending you to the same crappy place and location multiple times while sending others to Hawaii/Germany back and forth. Because I am prior enlisted I am lucky few that can get out exactly at 20 years!
 
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You made a smart choice for smart reasons. Milmed has more potential to close doors than it does to open them.
 
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Other cons for me were: less residency spots per speciality, training interruption via GMO, less pay post-residency for most specialties, and a probably a few others I can't remember.

I was okay with deployment, adventure, taking orders, challenges (both mental and physical), and danger. But feeling like I wouldn't receive the best training possible later on made me realize that I would rather take debt while pursuing the path that I want than be debt-free, but not continuing to develop my skills as a doctor in the way that I want.

You recognized the very real downsides of milmed and how they can delay/derail your medical career. There are a lot of positives to being in the military too but we each have to make up our minds as to whether or not it's worth the risk. Well done for making your own decision.

And thanks for the shout-out. I just added another notch to my keyboard :D
 
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You made a smart choice for smart reasons. Milmed has more potential to close doors than it does to open them.

Would you say there is any "smart" way for a physician to join? Such as taking FAP or direct commissioning after residency? The Army recruiter on SDN has said on here many times certain specialties can get 2 year contracts for either FAP or direct commission. Curious about what an insider would think about it.
 
I think it's less about the method and more about the personality of the person joining. Also, it's a bit about what specialty they end up practicing. So if you can do FAP, I think that makes more sense simply because by that time you know what you're doing professionally, and you know where you are in your life, and you know what your earning potential is.
In all cases, however, you need to want to be a military officer even more than you care to be a physician. That's the surest way to make sure you don't regret the decision. Because otherwise you're gambling on the whims of the Army to not $&@k up your life.
 
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I think it's less about the method and more about the personality of the person joining. Also, it's a bit about what specialty they end up practicing. So if you can do FAP, I think that makes more sense simply because by that time you know what you're doing professionally, and you know where you are in your life, and you know what your earning potential is.
In all cases, however, you need to want to be a military officer even more than you care to be a physician. That's the surest way to make sure you don't regret the decision. Because otherwise you're gambling on the whims of the Army to not $&@k up your life.

Would you say someone in the Guard has a lower chance of the Army "$&@k"ing up their life? If you hadn't picked AD would you go Guard knowing what you know now?

I'm not dead set on any path I just wanted to ask for future reference while I had you.
 
I have no idea. Knowing what I know now, I wouldn't associate myself with the military in any way. It was a bad deal for me personally for a variety of reasons. The biggest risk with the guard would be the massive loss of income when you're called away from your practice. Because it's not just the lack of billing for your services. Your staff still have to be paid. They don't just give up their livelihood so that you can go play in a field. That can be mitigated a bit by having partners. Or it can be eliminated by being an employed physician.
 
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I'm biased but personally think being Reserve or Guard is the single best way to serve as a physician outside the rare person who wants to be in the military more than anything and being a physician is just the role they chose to fill in the military. Yes, you will lose income and have to be selective about what kind of employment situation you pursue. That's a given for any kind of service commitment whether it is military, government, public health, international, etc. But the RC gives you more control, more stability, better practice opportunities, and generally a lower financial sacrifice.
 
Ditto DeadCactus. The Reserve Corps (at least in the Army), is a great way to titrate/taper your military commitment.

I seriously considered HPSP for a long time but ultimately opted not to for many of the reasons theonlytycrane mentioned. The big hitch for me was quality of residency training and skill development immediately after. The majority of the military residencies are on par with middle of the road community programs. The last military residency I would consider on par with the great ones would be military path and that ship sailed LOOONG ago. And immediately afterwards, for those critical few development years after, the tempo and diversity of cases pales in what you could get with a good civilian job. In short, if you are a decent to strong candidate in medical school, you will have much better training and professional opportunities as a civilian.

The Reserve Corps let me serve my country and take care of some excellent men and women in the Army. If I want to deploy to a bunch of different places, there are opportunities to do so for a few weeks to pretty much as long as I want. If I want to go active, I can do so for 2 years and transition back to Reserve Corps if I don't like it. I have a commitment (and it's more than the one weekend per month if you try to do the job right), but it doesn't severely prohibit my civilian opportunities. And my civilian opportunities make me a much better doctor and I can bring those skills to the table as a military doc.

Downside? You don't get the financial benefits that you would as an HPSPer. But with the Army at least, you get $250K towards student loans, which is nothing to sneeze at. I've been in closing in on 9 years and am not planning on leaving anytime soon.
 
wait but can't you do a civilian residency?
After HPSP? Only if the military tells you that you are doing a civilian residency, which is exceedingly rare for the Army, sometimes happens with Navy, and is almost the norm for several specialties with the Air Force.

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Assume you will be doing a military residency and be pleasantly surprised if you are allowed to head to a civilian one instead. Varies by branch of service and varies by particular needs from year to year.
 
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Air Force is pretty liberal in allowing candidates to pursue civilian residency right? If one could get into a civilian residency through AF HPSP, how extreme is skill atrophy for specialists during payback?
 
Air Force is pretty liberal in allowing candidates to pursue civilian residency right? If one could get into a civilian residency through AF HPSP, how extreme is skill atrophy for specialists during payback?
Totally depends on the year and specialty. Prob more likely than Navy or Army but don't count on it. The needs of the service are always forst and foremost.

Skill atrophy is also variable. Depends on specialty and assignment. On avg most surgical specialties are not seeing the volume or variety, but there are exceptions.
 
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Would you say there is any "smart" way for a physician to join? Such as taking FAP or direct commissioning after residency? The Army recruiter on SDN has said on here many times certain specialties can get 2 year contracts for either FAP or direct commission. Curious about what an insider would think about it.

I am not milmed, but one thing to consider is that when you accept a commission as an officer, which you will be as a physician, it typically carries an 8 year commitment with a degree of active service and then a reserve component to total 8 years. The reserve component can be in the IRR which used to be a safe bet for non-deployment but is not now.

If I am wrong about that, someone feel free to correct me. I haven't worn a uniform since 2005. Though they tried to make me put one back in during medical school in 2008 because of the, well, IRR.
 
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I am not milmed, but one thing to consider is that when you accept a commission as an officer, which you will be as a physician, it typically carries an 8 year commitment with a degree of active service and then a reserve component to total 8 years. The reserve component can be in the IRR which used to be a safe bet for non-deployment but is not now.

If I am wrong about that, someone feel free to correct me. I haven't worn a uniform since 2005. Though they tried to make me put one back in during medical school in 2008 because of the, well, IRR.

4 years of medical school(IRR) + 4 years of active payback I believe fulfills that commitment. (I haven’t looked at that regulation in years though, so someone with a more recent read may want to chime in)




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4 years of medical school(IRR) + 4 years of active payback I believe fulfills that commitment. (I haven’t looked at that regulation in years though, so someone with a more recent read may want to chime in)




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Nope. If you do an active duty residency, then those years pay back your IRR. If you train civilian, then you still owe IRR time after AD payback. Med school pays nothing back.

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Nope. If you do an active duty residency, then those years pay back your IRR. If you train civilian, then you still owe IRR time after AD payback. Med school pays nothing back.

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Not how it was calculated for me. I separated for a civ deferred fellowship and all my paperwork had my IRR commitment ending March 2018, to the day exactly 8 years from the day I swore into the IRR before med school.
 
Not how it was calculated for me. I separated for a civ deferred fellowship and all my paperwork had my IRR commitment ending March 2018, to the day exactly 8 years from the day I swore into the IRR before med school.
You lucked out. They calculated your time incorrectly.

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Not how it was calculated for me. I separated for a civ deferred fellowship and all my paperwork had my IRR commitment ending March 2018, to the day exactly 8 years from the day I swore into the IRR before med school.
They did this for a colleague of mine as well. I legitimately think it was because the GSs he was working with simply didn’t know.
 
You lucked out. They calculated your time incorrectly.

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I think someone had a regulation to quote on this now that you’ve responded that said what you are saying. But I wonder something....that 8 years isn’t an”commitment” in the sense that we commonly think of it. It is more of a “you will be in the Service for 8 years” thing whereas the 4 years is the true “commitment.”

If someone has that regulation handy I’d love to read the exact verbiage. I believe the 8 yr minimum is in Title 10 US Code.


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Not to hijack this thread, but I was under the impression that several of the military residency programs were very well regarded. Is this not the case?
 
Not to hijack this thread, but I was under the impression that several of the military residency programs were very well regarded. Is this not the case?

If by very well regarded you mean pretty average and adequate you’re probably right.
If you’re a superstar that can get into a top tier, actually highly regarded, residency program, you’re probably not in the same league. There may be exceptions, but that’s what they are.
I worked at NMCSD, “the starship of Navy Medicine”, the referral center for the pacific rim, and I’ve trained and worked at a couple world class academic referral centers. It really is night and day on every level in the surgery world.
My hardest days ever at NMCSD wouldn’t even register on the Richter Scale at these places.
Of course it’s specialty specific as well to some degree. What is good for a surgical or anesthesia resident is different for a FM resident dreaming of a low acuity office job in his sleepy home town.
And of course a career at one of the Meccas at the pointy end of the spear isn’t for everyone either, but if you can manage the worst of the worst with some skill and experience, the everyday emergencies are that much easier.


--
Il Destriero
 
This would be true if there was a decent amount of pathology/OR admins that actually cared about operative volume, but that is not the case. Do you know where we get the majority of our cases? Outside rotations.
 
Winning quiz show competitions is nothing like being the best residency. The idea that you're getting better operative experience at MAMC than Duke is just nonsense. And most importantly WRT surgical and procedural volumes, if the residents can barely get enough cases to be competent, the real problem is staying competent as an attending.
 
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Winning quiz show competitions is nothing like being the best residency. The idea that you're getting better operative experience at MAMC than Duke is just nonsense. And most importantly WRT surgical and procedural volumes, if the residents can barely get enough cases to be competent, the real problem is staying competent as an attending.

We have all seen those people before. Very book smart, but terrible in the OR.

We have no problem hitting our minimums here in urology thankfully. The next duty station, though, can be middle of nowhere with no robot access/nursing ability/ICU availability and maybe one major abdominal or pelvic case q2months. You can't maintain skills with that.
 
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