While the details are still fresh in my mind, I want to write down why I rejected the scholarship that the military offered me to pay for medical school. I spent months digging for any information I could find on the topic, so another motivation I have for writing this is that it will help someone else considering the scholarship have another point of view. With this scholarship, you are committing yourself to 4 years of school, 3-5 years of residency with the military, and at least 4 years of military service. There's not many contracts you can sign that have such binding force for at least 11 years of your life, so think twice and thrice before signing up. If you are interested in military medicine, be sure you spend some time reading the
military medicine page on studentdoctor.net. There, you can have the opportunity to ask actual military doctors questions. They certainly know more than your recruiter, more than current HPSP students, and even more than military docs who have been out of the service for a while. Realize, however, that it is often the sour grapes who are willing to spend their time ranting online, so take it with a grain of salt.
Anyways, this week Sharon and I moved out to Houston, Texas so I can start medical school at Baylor. We are really excited to be here and, so far, are enjoying our house, the neighborhood, the ward at church, and even the weather. Medical school is a whole new page in our life, one that will surely come with good hard times. One of the parts of medical school that can be difficult is finding a way to pay for it.
At the start of this year, Sharon and I started seriously considering joining the military to have them pay our way through school. The military has a program called the Health Professions Scholarship Program (HPSP) that covers the full cost of tuition, books, and required fees and also gives a stipend of $2,060 a month for living and other expenses. In return, you basically owe 1 year of service in the military for every year of scholarship money you receive, or you owe 1 year for every year of residency training you have, which ever is greater. Often, this comes out to 4 years of commitment, but it can be greater, as I will explain below. Most private and out of state medical schools out there have tuition in the range from $40,000 to $55,000 a year. For these schools, it is easy to see that when tuition plus the stipend is factored in, the scholarship would save a student anywhere from $260,000 to $320,000 dollars over 4 years of school. Nowadays, the 2 types of loans that the government offers most students have interest rates of 6.8% and 7.9%. Yes, that is insanely high, and yes, the rates were much cheaper 10 years ago when tuition was also significantly cheaper. Assuming a quick 10 year repayment plan and ignoring the fact that a student with a family and possibly without a family might not be able to make any loan payments while they are in their residency, the scholarship would save a student anywhere from $360,000 to $450,000. Residents in the military also make 20 to 30 thousand dollars more than civilian residents, which significantly adds to the savings accrued in the military.
In sum, that's a ton of money. For someone like me who has a family to support, the idea of not having an enormous amount of debt after graduation was very appealing. This is probably why many LDS families like ours consider HPSP. Some people have the idea that all doctors make tons of money and automatically assume than any educational debt they incur will be easy to pay off. Indeed, some doctors do make a lot of money, but some don't make very much in proportion to the debt they incur. For instance, primary care doctors don't make as much money as doctors who perform surgical procedures. It is not uncommon for family practitioners or pediatricians to start out making about $120,000. Since I have an interest in pediatrics, the thought of graduating with 300K in debt but only making 120K a year sounded scary. It seems many understand how stifling it would be for someone on a low-income career making 30K a year to have 75K in debt, but people seldom imagine that doctors can experience similar debt ratios. Keep in mind that doctors in this situation also worked their tail off to get there. With the elimination of the financial mountain of loans, and the addition of being able to serve my country, HPSP seemed like a promising opportunity.
Why, then, did I not join the military?
The first negative aspect of being a military doctor is that they don't make as much money as their civilian colleagues. As a doctor in the military, you can expect to start out making about 100K a year, maybe 130K for the higher paying fields. In the civilian world, you can make anywhere from 100K to 400K a year. It is easy to see that, for the higher paying specialties, HPSP doesn't save you any money at all if you plan on serving the 4 year commitment and then getting out. Physicians with higher incomes can actually lose 100's of thousands of dollars by joining the military. Even so, this is not why we decided to abstain from the military. We viewed this particular point as insurance. If I decided to be a primary care physician, then the military would, financially, be a great deal. If I decided to be a physician with a higher income, then even though I lose money while in the military, when I get out I have a high salary with no debt and we're still in a great situation. It's almost as if the money that was lost was spent on insurance premiums that we never needed. Better to be safe than sorry as a low-paid doctor with a mountain of debt, right?
The second negative aspect of being a military doctor that many people think of is deployment. During a time of war like this, doctors serving a 4 year commitment can expect to deploy at least once, probably twice. Deployments can last anywhere from 6 to 15 months. That is a long time to be away from your family, but it's an obvious necessity of military life. Aside from deployment during these 4 years, keep in mind that you have extremely little say in where you and your family are stationed. Even still, 4 years is only 4 years. We are generally positive people, and I think a touch of faith and prayer helps anyone to blossom where they're planted. Besides, isn't 4 years of difficulty less than the 8 years of financial security experienced during school and residency? To us, it seemed that the 8 years of plenty would outweigh the 4 years of potentially difficult military service.
The main reason why we didn't join the military is actually the training you get. Right before medical students graduate, they choose what kind of doctor they want to be and apply for residency training programs in what's called the match. Students list their top programs, programs list their top students, and hopefully you get matched somewhere so you can be the kind of doctor you want to be. About 94% of students match into a residency in the civilian world, which is pretty good.
The military match, however, is quite different. The military has their own programs which you must apply to. Due to the needs of the military being much more variable than the needs of the entire country, how many spots are available in a given year can be unpredictable. Additionally, with a limited applicant pool, the chances of a statistically high amount of students applying for a limited amount of spots becomes much greater. Furthermore, the military match system is based off of a unique point system. In this point system, things which have little to no indication of how good a doctor you will be are included, such as prior service in the military. This means that, when it's time for the match, I could end up getting royally screwed.
Let me illustrate what I mean with some actual data. In 2010, the navy had 55 HPSP students apply for spots in anesthesia residencies. 0 students got a spot, which means they either had to scramble for some other residency or they were forced into being a general medical officer (GMO) or a flight surgeon for two years. Both of these are basically like being an untrained general practitioner, although a flight surgeon does have a bit more training to specifically work with military personnel involved in air travel. The bad part is that not only have you delayed your residency for 2 years, but you have extended your commitment in the military for an additional 2 years. Yes, you have served for 2 years in the military that went towards your payback, but when you start your residency training you start accruing more time owed. After a 4 year residency, you will still owe 4 more years. Sounds weird, but that's how it works. Or, GMO tours aside, if anyone does a longer residency such as a 5 year surgery residency, they owe 5 years, not 4. The benefit of doing a GMO, however, is that once you're done you now have prior service. Thus, when you apply to the match, you have bonus points that can help you get competitive residencies that you might have been unqualified to get in the civilian world. Just like you got the shaft when you were a student applying for a residency and you were forced to do a GMO, now your role is reversed.
Although the navy is notorious for having an awful match rate and forcing you to do a GMO if you want a competitive specialty, the army is much better and boasts a match rate in the mid 80s. This is because the army is by far the largest branch of the military, so they have the most training spots available to match the highest demand. For this reason, I applied to the army. I usually put out a pretty solid application on things I apply to, and Sharon and I figured that the chances are better than not that I would get the residency I wanted. However, I still declined the scholarship.
The difficulty in obtaining fellowship training after residency training in the military was the real deal-breaker for me. In medicine, any sort of sub-specialty requires a fellowship. To do pediatric surgery, for example, you first do a 5 year general surgery residency, then you apply for a 2 year pediatric surgery fellowship. As you might expect, the military has little need for sub-specialists, and there is little guarantee they will have any spots available at all for a fellowship when you finish your residency. Furthermore, if there happens to be one available sometime during your military service, a majority of the time a fellowship will increase your service obligation. In the example of a pediatric surgeon, the doctor now owes 7 years of service. Not so good of a deal anymore, eh? What if you just want to pay back your time, get out of the military, and then do a civilian fellowship? This is doable, but it's simply less likely to happen. I hear and can imagine it's pretty tough to go from the doctor lifestyle with a 3 figure salary to the hectic, slaveish lifestyle of a fellow only making 50-60K a year. It's like taking a couple steps backward to go forward, and I can see myself not wanting to go through the hassle. In the normal, civilian world, however, most doctors do a fellowship immediately after their residency in a continual progression.
Sharon and I originally thought that not having to worry about shouldering 250-300K of debt would be worth bearing the brunt of military life. Luckily, my application took forever to go through so we had sufficient time to think about it before we made the enormous commitment to commission into the program. In the end, we realized that joining the military would be too much of a burden on my choice of a professional career. Sharon also realized that she is itching to settle down somewhere and simply doesn't want the mobile military lifestyle. Lastly, I started to agree that the advice I had heard many people say was probably true: don't do it only for the money. People who join the military should join in large part because they have a desire to serve their country, and other motivations like my desire to save a few bucks have a high chance ending in regret. Joining is committing in ink and blood to put the needs of the military and country first. I consider myself a patriotic person and would do my best to help our country in a dire time of need, but right now my family and career are my top priorities. Serving the USA would be nice, but it wasn't why I wanted to join, and joining for the money would have been a mistake for us (I would sure be kicking myself now that I got into a much cheaper school). If I knew I wanted to do primary care, if I had a spouse who was more excited about military life, or if I knew I didn't want to do a fellowship, the military might have been right for us, but it wasn't.
I do appreciate everyone who does serve, and now I just might understand a tad bit more than before the sacrifice you are making to serve us and your country. Thank you.
