Pros and Cons of military service to pay for medical / professional school- HPSP (the health professional scholarship program)

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about 5 years ago I was actually contemplating joining the military to help pay for medical school. I applied to a bunch of schools and one of them was the Uniformed Services University of the Health Sciences or USUHS which is located in bethesda maryland.

In this article I want to write about the pros and cons of the military as a way of financing medical education. I may not be fully aware of the recent changes to the HPSP program but I did a fair amount of research about the topic before I ended up not going though with it. I want whoever is thinking about doing this to think seriously and give it some critical thought before signing up.

How do i become a military doctor? There are basically 4 ways to become a military doctor. One way is to join what is called HPSP- health professional scholarship program. This is a program that you apply to when you apply to medical school. Each branch of the military offers this option. Another way is to apply to USUHS or the uniformed services university of the health sciences located in bethesda where you go to medical school as a military officer- think of it like a military academy for doctors to be. Another way is to do what is called FAP or the financial assistance program which you apply to when you apply for residency or during residency. In this case, they give you supplemental income for each year of your civilian residency program.

Are there financial benefits to joining the military? I think that a lot of folks decide to do this because they do not want to pay the 250 thousand dollars plus for a medical school education. The benefit of HPSP is that they pay your tuition + books + living expenses. USUHS does this also but pays you not a stipend for living expenses but an O-1 salary of an officer as you are considered active duty military during your schooling. FAP pays you a bonus every year in the range of 25- 30 thousand dollars and a stipend of somewhere between 1000- 1500 dollars per month for the duration of your medical training.

What are the obligations to the various programs?
HPSP - you are required to apply to a military residency program and possibly also get an opportunity to go to a civilian residency on deferrment. You are obligated to serve 4 years AFTER residency in the military as a physician. That number can go up if your residency program is longer than 4 years.
FAP - you serve one year plus the number of years you get your bonus. So if you signed up for 3 years, you will pay back 4 years.
USUHS - you will pay back 7 years after residency. So this is a program you go to if you are seriously considering a military career

does it make financial sense to do this? The answer is in most cases NO. If you are planning on doing family medicine or being a generalist, you will pretty much come out even but if you are going into a field like orthopedic surgery or neurosurgery, you will make a lot more money on the outside which will offset the large loan you initially take out for medical school even counting for the interest that you pay for those loans.

Here are some FAQs from studentdoctor network about the FAP, HPSP, USUHS programs
FAP
1. What are the benefits? Monthly Stipend of roughly $800 per 2 weeks for 21 pay periods + 3 pay periods at rank pay (2nd Lt) for completion of yearly ADT training. All Books, Fees, and Tuition to the medical school of your choice paid. Rank of 2Lt while in school and promotion to Captain upon graduation. Almost all military physicians make Major before their commitment is up.

2. What are the requirements? Pass Physical Fitness standards; Enroll in an accredited US medical school; apply and be selected (automatic acceptance is 3.5 GPA and 29 MCAT)

3. What will I make as a physician in the military? These are new figures calculated as of 2005 for a 4 year scholarship. I have factored in the cost of medical school education, stipend amount, and interest avoided to come up with a true scholarship value. This will then be calculated into what you receive in pay over the lifetime of your commitment. Pay is fairly comparable for the fields of FP, PEDS, and IM. ER is not far behind.

Scholarship Value
Medical School Education Loans Saved * 4 years: $154,000
Interest Saved: $25,000
Stipend Pay * 4 years: $65,000
Total Scholarship Value (4 years): $244,000 (61K per year of commitment)

Military Pay
Pay: 46K (Captain)
BAH: 10k (housing allowance)
BAS: 2K (food allowance)
VSP: 5K (specialty pay based on years)
BCP: 2.5K (board certification pay)
MASP: 15K (flat pay given to all doctors)
ISP: 13.5K (independent specialty pay based on specialty (FP or IM))
Total Military Pay yearly: $94,000
Avg. Malpractice Saving (FP & IM): $12,000

Yearly Compensation for 4 year commitment: $167,000
(Military Pay + Malpractice Savings + Scholarship Value)
(I did not take into account that a portion is not taxed)

Comparisons
Average starting salary for IM – Malpractice: $155,000 (after 3 years 172K)
Average Starting salary for FP – Malpractice: $135,000 (after 3 years 151K)

Military Pay Post-Commitment
After commitment is up, one looses the loan advantage and equivalent pay drops to about $106,000 per year.

Retirement?
Military retirement is 0% vested until 20 years, after which it becomes fully vested at ½ base salary (add 2.5% for each additional year up to mandatory retirement at 30 years). Most physicians that choose to stay till retirement will be Lt. Colonels. This means a yearly retirement pay of about $30-$35,000 plus lifetime healthcare benefits. Time in school is considered IRR butt does NOT count toward retirement.

4. What will I make as a resident?
A lot more….the average civilian resident makes 35-40K. 1st year (FYGME): Base Pay + BAH + BAS + 100 monthly for VSP = 59K. Residents: Base Pay + BAH + BAS + full VSP = 63K

5. Physical Standards You must meet officer height and weight requirements for all 3 branches to get the scholarship and periodically while in the military. The air force also has a PT test as part of the selection process. Each service does height/weight different.

The Army gives you two chances. First is height/weight. If you don’t meet requirements then they measure hip and neck circumference and use some quirky formula. As best I can tell the height/weight requirements for an army officer is 18 lbs above ideal body weight for those under 27 years of age. Women, Ideal Body Weight is = 105 + (5 * the # of inches above 5 feet tall)
Men, Ideal Body Weight is = 106 + (6 * the # of inches above 5 feet tall)
Example: 5’10” Male = 106+60+18 = 184.

6. Where will I do residencies/rotations?
http://www.mods.army.mil/MedicalEducation/

7. Is the four year obligation really only four years, or can a “stop-loss” order keep you in much longer? When does my commitment really end?
A stop-loss order in a time of war could keep you in, however it is unlikely and they tend not to keep you in for to long under those circumstances. All current military contracts are 8 years in length. In the case of a 4 years scholarship, ones contract would be for 4 years active duty and 4 years inactive ready reserve (IRR). While HPSP students are IRR, their time does NOT count. If a student did a military residency in FP (3 years) and then paid back his/her commitment (4 years), they would still have one year of IRR.

USUHS
I. What is USUHS?
- Uniformed Services University of the Health Sciences is a medical school that was created by congress for the purpose of educating miltary personal to become physicians in the Army, Navy (supports Marines), Air Force, and Public Health Agency. USUHS is located just outside of Washing to n D.C., next to the National Naval Medical Center in Bethesda MD.

II. Payback
- 7 year commitment, NOT INCLUDING internship + residency.
All in all: 4-years at USUHS + 1-year internship + 3-year (minimum) residency + 7-years payback = 15+ years in the military.
- USUHS = military career.

III. Benefits
- Rank of 0-1 with all entitlements while in med school. ~45,000$ per year, ~1500 of which is tax free. There is no rank progression while in school, but you are automatically promoted 0-3 upon graduation. For more info on pay as a military doc go to “HPSP FAQ” sticky
- The school has 0$ tuition, and most med school related expenses are covered…Lab fees, travel, books etc…

IV. Requirements as a student
- You are in uniform from day 1, no more civilian life.
- Strict rules of conduct, behavior, and physical fitness standards.
- School is all year around, no extended summer break. You start officer training over the summer before your first year of medical school.

V. Admission Criteria
(stats taken from US News and World Report)
- Avg GPA = 3.53
- Avg MCAT = 9.4 O composite
- Acceptance rate 15.5%
- Must pass physical standards exam
- Must pass National security inquiry
- 50% of all acceptances are people with prior/current military experience

FAP
FAP is a financial program that individuals sign into immediately before residency, or while in residency. The application process may be started before starting residency, but the contract starts when you sign (for practical purposes of discussion, immediately before the first day of residency).

The financial benefits
In this program you receive two types of payments during the residency year:
1) You receive a large check at the beginning of your residency year (e.g. July 1st 2006), and on each subsequent start of the next residency year (i.e. July 1st 2007, July 1st 2008 and so on) through the start of the last residency year. For example, an internal medicine resident signing before the start of a 3 year program will receive 3 large checks. In another example, a surgical resident in a 5 year program signing up at the beginning of his/her 2nd year will receive 4 large checks (for years 2 – 5).

2) You receive on a monthly basis a stipend (in addition to the annual check).

The current payments are (may be higher, subject to change, likely only “up,” but not by much in the current fiscal climate):
1) Annual check $25,049.
2) Monthly payments of $ $1,185.

The contract obligations
The contract obligation for this program requires individuals to enter active duty service on a “year for year plus one” basis. This means you must repay the service for each year you receive benefit plus one year. For example, an IM resident who received benefits for 3 years while in residency must serve on active duty for 4 years. In another example, a surgery residency who signed up at the beginning of their 2nd of 5 years of residency will have to go on active duty for 5 years. In addition to active service, you will have to remain in the inactive reserves (you don’t drill on the weekend etc, but you may be called up during time of war, vote appropriately) for a period equaling 8 years. For example, if you served on active duty for 4 years, you must remain in the reserves for an additional 4 years; if you served 5 years on active duty, you must remain in the reserves for 3 years.

If you drop out of residency, snort coke, etc, you will wish you were dead. There are stiff penalties for not completing the obligation; read on this elsewhere. This is not dissimilar to any other military financial program.

The practical benefits
-YOU decide and match into whatever CIVILIAN residency you choose, THEN sign into the military (unlike the HPSP)
-(Worth over-emphasizing) In this program YOU have COMPLETE control over the specialty you will enter, and the location/program (unlike the HPSP)
-Enter the fleet as a FULLY TRAINED physician in your specialty (unlike the HPSP for many)
-I am not 100% sure of this, but you may enter the FAP after HPSP (for those who know that the military is for them…as the obligation years really pile up)
-With this program you can delay your decision regarding whether or not to go into the military until AFTER medical school
-In residency you will make your regular residency salary (roughly $40-50K) PLUS the FAP payments (roughly $40K), allowing for a better standard of living during residency
-NO GMO tour if choosing the Navy route
-Practically speaking: have a pulse, not a fatty, not openly gay, in a competitive specialty, you’re in (no GPA, MCAT, etc worries, unlike the HPSP)
-While repaying your obligation requirements, you will earn a little more in that you’ve completed residency (possibly at a higher rank, possibly with board certification pay benefits)

Arguments to “wait and join the FAP later” instead of signing early for the HPSP
-You may decide during medical school that you don’t want to go into the military
-MANY HPSP recipients regret their decision (not so much the prior service recipients)
-Much of the positive HPSP feedback is either from prior service recipients who knew the military and knew what they were getting into, or from “new to the military” HPSPrs for whom the military is still new, exciting, and interesting—caveat emptor
-No military duties/rotations/service while in medical school
-Even though the concern of student loan debt is understandable when starting medical school, you will likely realize during medical school that the debt is a pittance in the long run, thus making a “grin and bear it” choice to enter the military less desirable means to finance medical education
-No military commitment hanging over your head in medical school
-Living circumstance in medical school may change (e.g. meet a significant other not fond of being a military spouse, children may enter the picture, etc)
-You may head to medical school interested in a lower paying specialty where the military financial trade-off doesn’t seem that bad (e.g. Family Practice) but may end up in a specialty where you could theoretically pay off your loans in one year (e.g. Radiology), making any long-term financial benefit moot.

Detractors against the FAP
-In the end, it’s still the military, and military medicine
-Almost NO ONE taking a military route will be financially ahead of their classmates who took student loans and a subsequent civilian job
-Earning ~$80k+ during residency will likely mean that you will have to go into student loan repayment, which for most people means spending ~$10k a year in payments
-FAP payments outlined above are subject to tax (at least the “large check” is)
-The HPSP allows you to live the ‘high life’ while in medical school on ~$1,185 a month, at least for those for whom $1,185 is the ‘high life.’

Certain student loans applied by the perspective students seeking to become military doctors are facilitated through an insurance carrier and hence the relevant insurance quote is written on the basis of the “pay-on-behalf” language. It is altogether different from a dental insurance or the most general insurance purchased by the majority of the population, health insurance that is safeguarded by the health insurance law.

THE BOTTOM LINE The finance physician ultimately does not recommend the military as a frugal way to finishing up a medical degree. It makes no financial sense to do so. Unless you have a strong desire to live the military lifestyle, it may not be for you.

Check out these other websites:
Pros and cons of miliary medicine
Veterans for common sense against military medicine
Pulitzer prize winning article on military medicine
physician retention issues in the military
one of the best websites on military medicine medical corpse

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