Air Force HPSP

[scrub-jay]

As I've mentioned here and there, my DH is considering doing the 3 yr HPSP for the Air Force. He is interested in being able to talk to someone who has gone down the same (or similar) path and would who be willing to speak candidly with him. Anyone's HPSP/military med docs/students interested & have time?

DH doesn't mind the format: phone, email, IM chat, this forum... he just isn't quite ready to jump in until he has more insight from those who are doing it.

Of course, on my little side note, if any spouses of HPSP/Military Med are willing to talk to me and give me candid feedback, I would LOVE that too. As it stands, I am supporting my DH either way but it would be helpful to have the real scoop to get an idea of what to expect.

Okay, I am rambling here. Any thoughts, advice, etc you can offer would be much appreciated.

Thanks!!



-C

[DCJenn]

The military has obvious benefits but for a lot of people, some significant drawbacks. We're not HPSP, and my husband was prior service so we knew what to expect and we're in it for the long haul.

I think HPSP in some ways in harder because with the military, the real benefit (aka the retirement) doesn't kick in until you've spent at least half of your career in the military. So, for those w/ a three or four year payback, you get all of the crap but some of the longer term benefits you will never see. For a 100% retirement, you'd have to be in for 40 years. But these days, even a 50% retirement is nice, especially if you can work in the civilian world for 20+ years. (We don't have that option- he's already 41 with 18 years in. We're in for at least another 6, probably longer)

I personally have no complaints at all about the military lifestyle. I certainly didn't love deployment. I won't love deployment when it happens again. I do love the certainty of knowing exactly when we'll be paid, that the retirement is maxed, that we get $1400/mo for housing, that we get two nice bonuses a year and that all of our healthcare is free. oh, and the college education is covered. (well, maybe- i'm not clear if we'll be able to use the GI Bill extension or not because my husband used it for undergrad. But, heck- even the idea is SWEET.)

So, there are pluses and minuses. I think the biggest minus is that as much as you have no control over where you go in medicine you REALLY have no control over where your go in military medicine. The more specialized you are, the fewer places you can go but obviously that adds time before you start the payback. (My husband did six years after medical school before he started the payback.)

Deployment sucks and is scary and depressing and then you get to feel guilty because even the docs on the front lines are more protected than the soldiers on the front lines. My husband dispensed Sudafed and cleaned out ears and took care of nasty feet in the Camp Cropper jail. The exact right place for a child neurologist.

Really, read my blog for the extent of my insanity.

I'll let the actual HPSP people answer your specific questions though.

[Rapunzel]

DCJenn can give you the positives.

I'll give you the other stuff:

- The military will decide your specialty in HPSP. If they have a need for what you want to do then they'll allow you to try to match in that specialty. If they don't have a need for what you want to do you either have to match in another specialty or go in as a general medical officer (without residency), serve your time, and then do residency AFTER the military commitment payback.

- Post-residency when everybody else is going to their new jobs that they chose in the geographical areas they chose you will go wherever the military needs you. You get very little choice in the matter unless you are so sub-specialized that you have limited yourself to a small handful of possible locations.

- You can count on being deployed. Deployments vary according to which military branch you are serving. But, the current minimum deployment time is six months (Air Force). These are very hard on marriages. We've seen two divorces after deployments in this last year alone among our military medical friends. The deployments don't make the divorces in and of themselves, but they are enormous contributors to already troubled marriages (think straw that broke the camel's back).

- Financially the HPSP option is a good deal for certain specialties in medicine. The general specialties such as Family Practice, Pediatrics, Internal Medicine, Ob/Gyn all can count on this financially making sense. The same can be said for some of the more "specialized" specialties. For other specialties such as the ROAD ones (Radiology, Ophthalmology, Anesthesiology, Dermatology) it is a very, very bad deal financially speaking. IF you have a rough idea of what you want to do for your residency consider the financial aspect for that speciality in the military vs. the real world. DH is radiology, for example. We've run the numbers of what the military paid for things vs. how much time it would have taken dh post-residency to pay back traditional loans vs. what he would be currently making (on average based on what all of his non-military friends are bringing in) and over the course of his military payback we will have lost a seven-figure sum of money. No joke. Definitely consider that aspect.

[mommax3]

DH was Air Force HPSP, was selected for a military residency, and then did four years of payback after residency. He has been out of the military for four years now.

I think the biggest issue for the two of you discuss before you make this commitment is what specialty(ies) your husband is interested in. As Rapunzel mentioned, the Air Force won't automatically okay every specialty if they don't need it. If he is interested in primary care specialties, he will most likely get to do what he wants to do. Other specialties.....who knows? Rapunzel also mentioned the salary differential between military and civilian docs, which is very real. I would not inculde OB/Gyn in the specialties where a military career makes sense, though. DH makes now makes almost triple what he made in the military. Autonomy is huge, too. DH works more now than when he was active duty, but he is his own boss. He can hire his own office staff and set his own policies. None of that is true in the military.

Like I mentioned earlier, DH was selected for a military residency. We (at the time) wanted a civilian residency and were completely surprised when we found out he would be doing his training in San Antonio. However, our time in San Antonio was the *best* part of being in the military, and if he had been able to stay there for his payback, I would have a very different opinion of military medicine. It was our time after residency (at Sheppard AFB in Wichita Falls, TX.....base hospital is now closed) that really was hard for both of us. Hard for me because I hated, hated, hated living there, 2.5 hours from *anywhere* else, and hard for DH because one of the OBs he was working with was from a civilian residency that lost its accreditation and was shut down the next year. She didn't have the skills needed to practice independently. Working with her was a nightmare for him, and the Air Force really didn't care. They even agreed at one point that she hadn't been properly trained, but instead of sending someone additionally to help out, they tagged DH and the other OB/Gyn stationed there to "train her", which meant one of them was always on call with her for the next six months. There was no way out of that situation, and it was bad.

The only way that I can see the military being a good option is if your husband is pursuing a low-paying specialty or if he is planning to do a fellowship and sub-specialize. Sub-specialists owe many years to Uncle Sam by the time they are finished training, but because they are so highly trained, they will be stationed at a major medical center which will most likely be in a good-sized city with more options for the spouse/family. Deployment will be a reality, though.

I can't speak from experience about deployment, thank God, because DH was never deployed. However, if he had been, he would have functioned as a surgeon in the field and I think that would have been very stressful for him, as if being deployed wouldn't have been stressful enough. The threat of deployment was minimal when he signed on for HPSP in 1993. The world has changed and I can't see him making the same choice now. DH and I have talked about this many times and agree that if he could do it all again, he wouldn't have signed up for HPSP. However, having said that, I have to also say that he feels that he received excellent training during residency, (he is actually in practice now with another graduate of the same program) and we met great people during our time in the military and got to experience a part of the country we never would have otherwise. Still, there was absolutely no sadness on either of our parts when the time came to get out!

Feel free to PM me for my email address if you have more questions or if your husband has questions for my husband.

[Urowife]

can't type much right now, but my DH did Navy HPSP. He's currently on deferment doing a civilian residency. He'll be starting his payback next year (4 years total). PM me if your DH wants to chat with my DH. He is always open to talk to folks about it. I'll try to get on later to post more of my own thoughts.

[Urowife]

These other folks have said pretty much what I would have said.

Plusses:
-Guaranteed job out of residency
-Paid for med school (i.e. less $ taken in student loans)

Minuses:
-Deployment (haven't experienced it, and I hope not to)
-The military has control over your desired specialty/career path (DH applied for a deferment for a fellowship and got rejected - the Navy just didn't have the need for that subspecialty)
-Depending on your specialty, your paycheck might be smaller than out in private practice

I'll post again if I think of anything else. It's tough to type with a sleeping baby on my lap.

[peggyfromwastate]

I'll agree that the Air Force has a much much tougher time getting the specialty they want. It's way easier with Army. We are soooo glad we went with Army-- otherwise we'd most likely be stuck with some GMO like most of our AF friends were. So, this is really something to carefully consider before signing up- unless he's sold on doing a primary care field. Then he will probably get it.

[madeintaiwan]

We didn't do the AF HPSP for the reasons that others have stated. My husband went through the whole application process and was even accepted but we ended up declining. To which they had numerous people call him to see if he would reconsider. There was a guy in the class before him that was AF HPSP who matched into ortho but wasn't allowed to do ortho. The AF made him do another specialty. My husband didn't want to risk that happening to him because he was pretty certain that all he wanted to do was ortho. Or at the very least wanted to be able to do whatever he matched in. We had two kids while in medical school. Started with one and had one during MS2. We have a ton of educational debt, but my husband is a PGY3 in ortho. Good luck to you guys.

[scrub-jay]

This is great information. DH has been flip-flopping on his decision and we love the real-life perspective. He will be attending CU (University of CO) which for us, will be out-of-state tuition. (They've created a new rule where you stay Out-of-state for the entire 4 years even if you and your spouse establish residency...boo!) That is the financial aspect.

As for specialty, he is dead-set on Neurology. He began as a psych major, then loved all of his neuro-psych classes, immersed himself in MRI & psych research, then worked with a neurologist in a VA clinic. For my DH, it was the pursuit of neurology that sparked his interest in medicine, so yes, specialty is a huge deal.

I love all of the feedback from you, it is very helpful.

[DCJenn]

Well, I can tell you that the military is in desperate need for neurologists and I would imagine that getting THAT particular specialty wouldn't be difficult.

AF neurologists train at civilian hospitals. Army and Navy neurologists train at military facilities. Of the three child neurologists that are recent graduates who are AF, two trained at Stanford and one at Children's National Medical Center in DC.

If he wants to talk to my husband about military adult or child neurology, let me know. The Child neurologists have to do a year of adult neurology in their child neurology fellowship.

Jenn