Ask the Half M. D.: but seriously, what’s the catch?

March 4, 2009 at 10:31 am (Military medicine)

I just don’t get it. About once a month I post a rant about how bad military medicine is, point to other resources about life in the military, and link to stories by other physicians about how they’ve been cheated, wronged, or just plain screwed by the armed forces. I even posted a pretty graph to show the loss of income by taking the scholarship. And yet I still continue to get questions along the lines of “Are you serious? Really, it can’t be that bad. What are the advantages?” Here is the latest email I have received from a reader who poses several questions:

1) I am slightly confused about residency in the military. I heard that its TYPICALLY (for usuhs/hsp) 4 yrs med school, 1 yr internship, 2 yrs GMO, n years residency. In other words, despite 75% matching, i heard that the 25% that fell short still do eventually get a residency (i.e. at least fam med/int med/etc.) Albeit, i think this ends up extending ur service years since GMO yrs dont count toward satisfying reqts.

A GMO tour does indeed count towards your payback. If you take the four-year scholarship and do a two-year stint as a flight surgeon, you would only need two more years of active duty service. However, once you start a residency, your commitment will increase. Attending residency is entirely your choice. So yes, most of the people who did not match will eventually end up in residency, although they might wait until their commitment is up so that they can pursue civilian training.

2) how dangerous is being a military physician? What the most danger that theyre in (same danger as combat soldiers vs. supply line soldiers vs. etc)? (i assume the least danger would be at a well established command area)

You’re in the military. You will be deployed. You will face danger on these deployments. Military physicians are listed as noncombatants under the Geneva Convention. However, I am unaware of any nation—including our own—that actually follows the Geneva Convention. Doctors have died in combat in the past, although it is a rare event. Usually, they stay on base at the hospital and don’t travel out with the soldiers on combat missions.

3) Also, do u think that usuhs/hsp prevents u from living at LEAST the stereotypical middle class life (2 toyotas/house/2 kids/retirment/bla bla)?

I have no idea what you’re talking about. Do you mean that taking the scholarship will allow you to live a middle-class lifestyle as a student? USUHS students make above $40,000 a year. HPSP students make around $25,000 a year. Military residents start at $65,000 a year and go up from there. Flight surgeons make about $95,000 a year and up, while board-certified attendings in other specialties start at $120,000-$140,000, depending on specialty. I’m not sure if I’m able to answer your question, but that’s the money that you can expect.

It would be a great help to hear ur input, as opposed to hearing recruiters only. Also, if this isnt too private, why did u decide to do the hsp when it seems like u really are against it? Im just trying to get all the facts before deciding to apply to the usuhs/hsp. Thanks.

Unfortunately, I did not have all the facts when I took the scholarship, which would explain why I’m so against it today. I really think you should… forget it. Just take the scholarship because you obviously don’t care to listen to what I or anyone else has to say about it. Keep my email address handy so that you can let me know how things work out for you during January of your senior year of medical school.

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Despair through pretty graphs

February 21, 2009 at 2:11 pm (Military medicine)

I recently wrote an article about some of the misconceptions that medical students have regarding military medicine. I want to drive home the point about having a lifetime net loss of income by taking the HPSP scholarship, working for four years as a flight surgeon, and then getting out to pursue residency training. I created the pretty graph below to illustrate just how much money you will lose by taking this scholarship.

lost_money_in_military

Don’t blow off money as if it’s no big deal. Many of the premeds who read this blog are 21-years-old or younger, single, and have been living in student poverty for the past few years. Granted, $95,000 a year as a flight surgeon will enable you to do pretty well if you’re single and living in an area like Texas where housing is cheap. If you’re married to a housewife, have two children, and are stationed in San Diego, $95,000 a year isn’t going to get you very far. Realize that many things change during medical school and residency. Your priorities at the age of 21 are going to be vastly different than your priorities at the age of 27.

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Sorting fact from fiction

February 19, 2009 at 2:10 pm (Military medicine)

Over the past few months I’ve been collecting questions from first-year medical students about statements they’ve heard regarding military medicine. Much of the information that they’ve received from recruiters has turned out to be false. If you are considering a career in military medicine, I urge you to carefully consider the consequences of taking the scholarship. Here are some of the lies that I’ve heard:

“There is a 98% match rate in the military.” — There is a 75% match rate in the Air Force, and the Navy is much lower. People who do not match through the military are usually forced to become general medical officers, dive medicine officers, or flight surgeons.

“If you don’t match in the military, you can always try the civilian route.” — Absolutely false. If you don’t match in the military, you don’t match at all. You’re certainly welcome to apply for a civilian deferral at the time that you apply to the military match. However, there is no guarantee that you will ever be granted a deferral to the civilian world. The only determinant of whether or not you get a civilian deferral is through the military match. If you fail here, you won’t be training in the civilian world in any specialty.

“Everyone is guaranteed a residency.” — Not quite. Everyone is guaranteed an internship. Only 75% will get a full residency.

“You can never be forced into a specialty that you don’t want to practice.” — Partially true. The military can force you to become a general medical officer or a flight surgeon as these two professions are not considered true specialties by the military. You cannot, however, be forced into a categorical residency program. A note about flight surgeons: you will receive specific training to their discipline in the form of the aerospace medicine primary course. Although I would like to believe that unique training is a qualification for a specialist, the military does not share my thoughts.

“Flight surgery is the greatest thing since sliced bread.” — That depends on what you want out of life. If you want to be a general practitioner for pilots and their families, then you might enjoy flight medicine. However, you will not become a licensed pilot simply by attending the aerospace medicine primary course. And despite the term “surgery,” this field of medicine has nothing to do with operating.

“You can operate in the back of an aircraft.” — Are you kidding me? Hell, I was even told that flight surgery was a route that orthopedic surgeons choose to enter so that they can design more ergonomic planes.

“You will financially break even if you take a scholarship.” — Absolutely false if you want to enter any profession other than primary care. Let’s say that the Air Force spends $250,000 on my medical school education and then forces me to become a flight surgeon, making about $95,000 a year. If I had opted for taking out student loans and then going for residency and securing a job that pays $200,000 a year, my net gain would have been $330,000 over my lifetime. With a $300,000 job, the net gain would be $830,000. Simply put, I will lose over half a million dollars by taking this scholarship.

If I haven’t deterred you from considering the scholarship, at least ask your recruiter for the names of several physicians who have entered the military through the HPSP program. If he can’t give you any names, hang up immediately and never return his phone calls.

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The Air Force’s new advertisement for flight surgeons

January 13, 2009 at 12:03 am (Military medicine)

The military is currently facing a critical shortage in the number of flight surgeons. The Air Force in particular has been struggling over the past few years to fill its numbers with qualified doctors who can take care of pilots and their families. Recently, the Air Force began development of a new advertising campaign in an attempt to draw more flight surgeons. As an exclusive to this website, I have obtained a copy of the first script and will share it here:

Hello, my name is Captain Martin. I’m a flight surgeon for the best Air Force in the world. Just to show you how wonderful things are here in the USAF, let me share with you my previous week.

Monday: I got to meet real, honest-to-God pilots today. They were so friendly… so tough in their flight suits. I think that I’m going to get a flight suit, too. Joy! The colonel says that if I act right, he’ll let me hold the stick the next time we go flying.

Tuesday: I went to the confidence course today. The Air Force uses the term “confidence” because the outdated term “obstacle course” is too negative. I had such a wonderful time. As I was climbing the ropes, rock ‘n roll music was playing and everyone was saluting me. It was awesome!

Wednesday: I went to clinic today and saw patients.

Thursday: I had to get up at 4:00 a.m. this morning for mandatory physical training. I knew that being in the Air Force would be tough, but I guess that all this training is great so that I can buff up and women will stop laughing at me when I tell them that I’m in the military.

Friday: my assistants did not show up to the clinic today until after 11:00 a.m. It was no big deal. I couldn’t find any of the patients’ charts anyway. I just went from scratch like I did back when I was in medical school.

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Results from the military match are in

December 17, 2008 at 11:20 pm (Military medicine)

There are a few people who were using my website to find the military match results that were released on December 17. The results from the Air Force and Navy are available on publicly accessible websites. However, I believe in the privacy of the applicants. Therefore, I will not post those links—although I’m sure you can find them elsewhere. The Army will not publicly release the results at this time. I will, however, list the number of people at matched into each specialty for the Air Force. These numbers include both medical students as well as physicians who are transferring into these fields.

Anesthesiology 23
Emergency medicine 35
Family medicine, flight medicine 6
Family medicine 46
General surgery 29
Internal medicine 34
Neurology 4
Neurological surgery 1
Obstetrics and gynecology 17
Ophthalmology 6
Orthopedics surgery 13
Otolaryngology 6
Pathology 7
Pediatrics 31
Psychiatry 10
Radiation oncology 1
Radiology 18
Urology 7

There were 63 people who matched into PGY-1 years only. Most of these people will be forced to go into flight surgery or GMO routes in the future. There are several specialties that I did not include in this list such as aerospace medicine and dermatology because medical students are not allowed to apply for these positions.

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Hot off the presses: the Air Force is out to screw medical students

June 4, 2008 at 11:08 pm (Military medicine)

I was browsing through the Air Force’s website for graduate medical education today when I came across a letter from Colonel Hall, the director of physician education. She states that the selection rate for medical students is as high as 75%. What that means is that 1/4 of fourth-year medical students applying to residency will not match. That’s a pretty disheartening statistic to read, especially given that more than 94% of applicants match through the civilian route. I remember being a na‹ve pre-med who bought into the lies told by recruiters that 98% of medical students enter the specialty of their dreams. If I had known then that I’m about to spend several years as a general practitioner, I never would have accepted the scholarship.

Even more disheartening is that this chief does not seem to know how competitive certain Air Force specialties are compared to their civilian counterparts. She writes, “The more competitive or popular specialties such as Anesthesiology, Radiology, Emergency Medicine, and the Surgical sub-specialties have a higher non-selection rate than some of the Primary Care specialties- paralleling the outcomes in the civilian match through the National Residency Match Program (NRMP).” Anesthesiology and emergency medicine are competitive in the civilian world? According to the data published by the AAMC, anesthesiology and EM are only moderately competitive at best. With greater than 90% match rates in both specialties, the average medical student certainly has a shot at getting into these fields.

Christ, why did I ever sign up for this?

Update: you can’t watch television or a movie these days without seeing some high school student boasting to his parents that he can get a free college ride by enlisting in the military. Historically, the Montgomery G.I. Bill has provided educational benefits to veterans in return for their service. Currently, the G.I. requires a buy-in of $100 per month for the first year of service only to provide a little over $1000 monthly in educational benefits after leaving the military. Other than community colleges and a small number of state universities, few places offer annual tuition costs at less than $14,000. Even then, the money does not cover all of the necessary living expenses, books, and equipment that is incurred as the reality of obtaining a college degree. Recently, Senator James Webb of Virginia has introduced legislation which would guarantee four years of tuition at most expensive public schools in addition to living expenses. His reasoning is that the current G.I. bill needs to be overhauled to perform its stated mission. His bill cleared through the Senate with a 75 to 22 bipartisan vote. But guess who is opposed to this legislation: Bush II and Bush III. And I thought medical students had it bad.

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What the civilian match means to HPSP students

March 24, 2008 at 9:08 pm (Military medicine)

I watched my university’s Match with great anticipation. As a member of the military, I’m required to apply for military residency at the beginning of my fourth year. While the Air Force does grant deferrals to attend civilian programs, the military residencies have first dibs on the applicants.

I took some numbers from last week’s Match in emergency medicine and came up with the following:

1,235 U.S. seniors applied for 1,475 spots in emergency medicine nationwide. Of these seniors, 1,128 matched (91%), and an additional 22 seniors went into combined programs such as internal medicine/emergency medicine. 30 residency spots went unfilled.

Further, I went through the AAMC’s data on the applicants to EM programs. The average STEP I score was 220, half of the applicants did not have publications, and the vast majority did not belong to AOA.

In conclusion, looking over the board scores and other application data from last year, I’m reasonably sure that if I were a civilian, I would have no problem matching into EM.

But I’m in the military—which means that I only have a 30-50% chance of matching when I apply next year. That’s something the recruiters never told me when I took the HPSP scholarship. More likely, I will be forced to into a one-year internship and then released into the world as a flight surgeon. Just think, my career goals are about as far removed from primary care as they can get. And so what is the Air Force going to do? Force me into primary care along with 70 other fourth year medical students who had other dreams.

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Results from the military match

January 20, 2008 at 2:21 pm (Military medicine)

I finally got around to tallying all the numbers from this past December’s Air Force match:

Anesthesiology – 8
Emergency medicine – 15
Family medicine – 44
General surgery – 20
Internal medicine – 31
Neurology – 5
Neurosurgery – 1
Obstetrics and gynecology – 24
Ophthalmology – 3
Orthopedic surgery – 5
Otolaryngology – 7
Pathology – 4
Pediatrics – 29
Radiology – 4
Psychiatry – 7
Urology – 4

71 people were selected for one-year internships. My guess is that most of them will be forced into GMO/flight surgery tours. The Air Force continues to maintain that 98% of applicants got their top pick for specialty. I just don’t see how 1/4 of medical students would want to go into general practice.

I personally know one person who applied for emergency medicine and orthopedic surgery, yet was forced into a transitional year. He was prior service military. That makes me think that I have no shot at getting the specialty I want. Well, at least I’ll learn how to fly a jet.

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How to make money off of the HPSP program

December 17, 2007 at 11:03 pm (Military medicine)

The military’s HPSP scholarship program pays for all expenses related to medical school training including tuition, books, and necessary supplies such as a stethoscope. The scholarship fund also provides money for room and board in the form of an annual salary. Currently, the military pays us just over $21,000 a year. While this amount sounds like a lot for a student, it is hardly enough to get by when attending a school in a major urban area. A few weeks ago I had a realization that military students can use the HPSP program to their benefit and generate additional income through investing.

The Department of Education currently allows graduate and professional students to take out federally subsidized loans up to $8,500 each academic year. That’s a free loan. And for students who can invest the money, all of the profits made off of the interest is theirs to keep.

Let’s say I withdraw $8,500 annually and invest the money, for a grand total of $34,000 borrowed over the course of four years. For this scenario, I will pay back all of my student loans the day I graduate medical school. I started running some numbers and here’s what I found:

If I invest in a relatively safe mutual fund that has a 7% gain each year, I’ll graduate with just over $40,000. That’s $6,000 for free. Now that may not sound like a lot, but six grand can pay for quite a few toys leading up to residency.

If I invest in a high yield mutual fund and it brings in 20% a year (and there are quite a few of those), I’ll finish with $54,000-a total profit of $20,000! Now that’s a new car.

I wish I had thought of this scheme when I first started medical school. I’ve already filed my FAFSA and am waiting to hear back on withdrawing a lone starting in the spring semester. If my calculations are correct, I might be able to pull in between $1,000-$5,000.

I wonder if anyone else has thought up this idea. I haven’t seen it online anywhere, but I’m sure that other students have tried it before.

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The military match results are in. No one cares.

December 17, 2007 at 12:54 am (Military medicine)

Every year medical students in the HPSP program as well as students from the Uniformed Services University (USUHS) must participate in the military’s residency match program. The military’s match program is loosely based upon its civilian counterpart. For example, program directors take into consideration grades, board scores, research publications, interviews, etc… However, just like everything else in the military, the armed forces has found away to formalize the process to such a high degree of micromanagement that the entire system is no longer meaningful. For medical students entering in the military match program, they have to wade through a confusing point system that churns out an score for all applicants based on factors such as class rank, prior military service, and “ability to become an officer.” Further, residency program directors have no control over who actually gets selected to attend their particular institute. Instead, a group of the three services’ top leaders convene one week during the fall and decide the fate of all military medical students. The whole process is rather nerve-racking for those of us in the HPSP program. This past week, the military once again held its annual match and crushed the dreams of many people seeking to enter their desired specialties.

The Air Force released its results on a public website in the form of an Excel spreadsheet. Out of privacy concerns for others, I will not reproduce that website here. However, I’m sure that he do some searching around you can find it yourself. Looking over that chart I noticed that over 25% of medical students are matching into flight surgery. For those of you who don’t know, flight surgery involves a one-year internship, six weeks of flying lessons and aerospace medicine, and then it’s off to the clinic to work as an attending. Certainly, anyone reading this blog will instantly realize that flight surgeons are missing out on a lot of valuable training in residency. By granting only one year of training, the military is creating an entire generation of physicians who aren’t fully prepared to become doctors.

For the Air Force, flight surgery is a wastebasket to force all non-matching students into a particular field of medicine. The title “flight surgery” is a misnomer. It has little to do with flying, and nothing to do with surgery. While I will grant that some people are willing to enter this field, surely 1/4 of applicants do not want to have an internship serve as their terminal training.

For the rare student who did match to his chosen field, he can breathe a sigh of relief as his senior year in school is over. But for those students who did not match into their chosen field or location, the next 5+ years are going to be very difficult. Each year that passes I grow more and more nervous about not getting the field that I want, and getting forced into flight surgery. While the prospect of learning how to fly is appealing, more than anything I just want to be a practicing physician. I’ve mentioned earlier on this website about the problems of taking the HPSP scholarship. However, money is not the only issue. Upon learning that I have no control over my future training, I feel as if the military has led us all into one great big lie.

I’m bound to get hate mail from the “patriots.” I signed up with every intention to serve. However I didn’t think that the military would deceive me over the amount of education that I would receive. Further, my role in the military is to be the best doctor I can be. And without that extra training, I’m doing a real disservice to the nation’s soldiers.

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