Doc 721 Pre Residency Assignment

[Editor’s note: This is a guest post from long-time blog reader and frequent commenter Beau Ellenbecker, DO, a private practice family practitioner who spent a few years in the Army after accepting an HPSP scholarship to pay for medical school. Similar to me, he has mixed feelings about his decision. In 2007, he wrote an HPSP guide for a student doctor website. He sent me his recent revisions which I thought were worth publishing as a guest post. Those considering this scholarship would be wise to read this prior to making a decision. Beau and I have no financial relationship. I’ve interspersed a few clearly-marked comments, mostly by way of clarification throughout his post.]

In 2003 I accepted a 3 year HPSP scholarship in the Army.  I completed the final three years of medical school under scholarship, then moved to Hawaii for a 3 year military residency, and finally finished my obligation with a 3.5 year assignment in Europe that included an 11 month tour of duty in Afghanistan.

My Experience With the HPSP Scholarship

1. The Pay

  • Signing bonus of $20,000 (variable based on needs of the miltiary)
  • Monthly stipend of $2100 a month for 10 and ½ months per year
  • 2nd Lieutenant pay of $2900 a month for 1 and ½ months per year
  • Total pre-active duty pay: $126,000
  • All books, fees, and tuition to the medical school of your choice in the USA or Puerto Rico
  • Adventure, jazz, props from the public, a nifty uniform, and the sense of pride with military service
  • Rank of 2nd Lieutenant while in school and promotion to Captain (Lieutenant in the Navy) upon graduation. Most military physicians are promoted to Major (Lt. Commander in the Navy) at 6 years of active duty (counting residency)

2. What Are the Requirements? 

Pass Physical Fitness and weight standards regularly, be eligible to be commissioned as an officer in the military, enroll in an accredited medical school, apply and be selected (automatic acceptance for Army is 3.5 GPA and 29 MCAT)

3. What is the Payback?

Dr. Ellenbecker enjoying his time in Afghanistan

One year of service per year of scholarship received. Military residencies do count as payback, however, you also accrue one year of payback for each year of residency after your FYGME (Internship) year. In other words you can complete one extra year of residency past your level of commitment without incurring more time. (4 year scholarship recipients can do 5 years of post-grad training without accruing more time). Also if you do a civilian residency you payback will not start until you start on active duty. [Editor’s Note: As a general rule, you’ll have the same payback whether you are chosen to do a military or a civilian residency.]

4. What Will I Make as a Physician in the Military? 

These are new figures calculated as of 2014 for a 4 year scholarship. I have factored in the cost of medical school education, stipend, bonus, and interest to attain a scholarship value.

Scholarship Value

Medical School Education Loans Saved * 4 years: $160,000
Interest Saved: $77,000 (Based on 10 years at 6.5%, post residency)
Pre-Residency Pay: $126,000

Total Scholarship Value (4 years): $363,000 (about 91K per year of commitment)

[Editor’s Note: I thought this was an interesting calculation. The value of the “scholarship” to me was much closer to $100K given my very cheap medical school, the interest rates available upon my graduation in 2003, and the much lower pre-residency pay provided then. I’m not surprised to see it is more valuable now given rising tuition, higher student loan interest rates, and the difficulty the military has had acquiring physicians given the high deployment ops tempo in the last decade.]

Military Pay (average stateside)

Pay: 46.8K (Captain)
BAH: 16K (housing allowance, varies by location)
BAS: 2.5K (food allowance)
VSP: 5K (specialty pay based on years)
BCP: 2.5K (board certification pay)
MASP: 15K (flat pay given to all doctors)
ISP: 20K (independent specialty pay based on specialty: Family Medicine)
Bennies:  30 days paid vacation and free health/dental/vision

Yearly Pay as a Practitioner: $108,000 

Yearly Compensation as a Practitioner for 4 year commitment: $199,000
(Military Pay + Scholarship Value/4 years)

Average Starting salary for a civilian FP: $145,000 [Not sure of source for this, but at least one easily found source suggests the figure was $170K in 2012. If anyone has current MGMA or other survey data for 2014 I’ll replace it here. Bear in mind that this figure may be much higher for your specialty, and even for your individual position- which may be far above average.-ed]

If you choose to stay in the military there are bonuses for resigning that significantly improve your pay however they require multi-year commitments. Currently a four year commitment for a family doctor signed AFTER your initial commitment is worth $30,000 annually. [Editor’s Note: It should be noted that these bonuses are highest when your initial commitment is up and quite a bit lower as you approach the magical 20 year mark where you become eligible for a military retirement. The military has thought about all these incentives and uses them to “force-shape.”]

Yearly Compensation as a Practitioner after signing a 4 year ADD ON post initial commitment: $165,000 
Pay is pretty competitive for primary care, for specialists it is not even close. A cardiologist in the Army can expect to make at most about $200k. In the civilian side its closer to $300K.

5. What Will I Make as a Resident? 

Yearly Pay as a Resident: $65-70,000 (No ISP, MASP, or BCP)

Average pay for civilian family medicine resident – $42-60,000

6. Where Will I do Residencies/Rotations? 

Really depends on which service [and specialty-ed] you select. However, I strongly suggest that you do a rotation in the specialty you desire at your top location choice. Most Navy and some Airforce candidates will be required to do GMO/Flight Surgeon tours after their internship (2-3 years) and before residency. You can gain valuable experience but personally, I hate this idea.  It puts the least capable and least educated physicians in often isolated environments and makes them responsible for a majority of troop health.   The army really only does this if you switch specialties and there are no residency spots available in the specialty you want. [Instead, the army fills these slots with fully board-certified doctors, like a pediatrician working as a GMO/Battalion surgeon after finishing a 3-year peds residency.-ed] Of note, if you chose to get out after you serve extended time as a GMO (if your contract is up), it may be harder to get a civilian residency as you are so far removed from your internship and schooling.

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 highly unlikely given previous use.

7. Assuming a Four-Year Obligation After Residency, How Many Times Can They Make You Move (not counting a deployment, of course)?

1-2 times after residency, unless you are really unlucky. A stateside tour is 2-4 years. Overseas tours are 2 years if you don’t have family and 3 years if you do.

8. Since HPSP Students Are in the Reserves During Medical School, Can They Be Called up Even Though They Have Not Completed Their Medical Education for Regular Reserve Duty? 

No. Under no way can you be pulled out of school or your 1st year of residency.

10. State School, Private School, or Daddy’s Pocket? 

You should not take the scholarship for the money. You will regret it. You must have a desire to serve in the military. The military is not for everyone. That being said, you will regret taking this scholarship if you are going to a medical school that costs less than 20K a year. The money you will make early in your career would easily offset such a cheap education loan.   Had I gotten into a state school I would not have taken the scholarship.

Dr. Ellenbecker enjoying his time as a civilian

11. What About After Graduation?

The military requires that you apply for a military internship year (FYGME). Nearly everyone will do a military internship. Your FYGME will either be in your field of choice (possibly fast-tracked into a residency) or done as a traditional rotating internship year.  In most cases, if you don’t match in your field of choice you can defer out and do a civilian residency after completing your FYGME year however you must be accepted to a civilian program in that specialty.

[Editor’s Note: By way of clarification, all med students with a military commitment must go through the military match. This has two parts- first for specialty, then for program. If you are not selected for your specialty, the military may put you into a military internship you have zero interest in, such as a surgical internship, then assign you as a GMO. Once you are selected for your specialty, you will either be placed into a military program or you will be allowed to go through the civilian match. You can rank these options in the order you prefer, but the process does not necessarily favor the applicant in the same manner as the more objective, computerized civilian match. This process for your specialty is controlled by a handful of people sitting around a table. For the most part, they are good people who try to do what is right and give you what you want, but they are limited by the “needs of the military” and inevitably, some people (usually the least competitive) do not get what they want. It helps a great deal to figure out who these people (your service’s specialty leader and the residency program directors for your specialty and service) are and personally meet, and impress, them.]

12. Retirement

Military retirement is 0% vested until 20 years, after which it becomes fully vested at ½ base salary. Most physicians that choose to stay till retirement will be Lt. Colonels (Commanders for Navy). This means a yearly retirement pay of about $40,000 (indexed to inflation) plus lifetime healthcare benefits. There is, however, talk of modifying the retirement pay.  Retirement is pretty good if you stay 20 years as you can still get another job however you HAVE to finish 20 years to get anything. That to me is a big drawback.  The military also offers the Federal TSP (like a 401(k)). There is no match, but the investment options are the cheapest you will find anywhere.

13. Why the Army? 

Why did I select the Army? Several reasons actually. I have family history in the Army which made me lean one way, but the Army has a lot more scholarships and residencies then the other branches as well. I applied later in the year so my best shot was in the Army. The Navy had some drawbacks for me, mainly in the form of the required GMO tour. The Navy and Air Force arguably have better residency and base locations.  I think branch of service is more a personal choice than anything else. However, if I had the opportunity to make my selection again I would probably choose the Air Force.

16. What Was My Career Like in Army Family Medicine? 

I completed medical school in May of 2006 and 5 days later moved to Hawaii to begin my residency at Tripler Army Medical Center. Hawaii isn’t a bad place to do a residency. I enjoyed my non-working time there and work was tolerable. Tripler is a major medical center so as a family resident I was a little bit disadvantaged when it came to procedures and learning in some of the departments as they tend to teach their own residents first. A medical center does usually provide a nicer call schedule in 2nd and 3rd year than a hospital with only family medicine residents would. Overall, my experience was like most residencies. I would say on a whole that we probably had a smaller inpatient population then some civilian residencies yet we still saw quite a bit of pathology.  We also completed a lot more inpatient rotations and OB care than most civilian residencies.

Personally, I think military residencies lack a little in breadth given lower patient volumes but make up for it greatly in depth.  I can almost immediately tell a military physician from a non-military physician just by reading a few notes.  Military docs tend to write much better and more meaningful notes and tend to be much more cost-effective than civilian docs.  Most notes I read from civilian internists are so poor in quality that I can’t tell what has been done to the patient or what their plan actually is.

Each specialty and branch treats your first assignment differently. For my specialty, we are interviewed about where we are from, where we would like to go, and what is most important to us (i.e. location, clinic job, hospital job, unit based job). My wife and I were leaning towards leaving the military and felt that we would only get one shot at living overseas so I volunteered for Germany, however, I was insistent on going to clinic as I felt a unit job wouldn’t provide the continued learning I felt I needed leaving residency. The interviewer then weeds through all the candidates and tries to match you as best as he can to a future assignment. Not everyone gets their top choice, but the guy actually does a pretty good job. If you are a good candidate (chief resident, high board scores, former military) or know how to work the system you can sometimes help the process along. In my case, contacting the commander where I wanted to go and being chief resident helped me get the particular base in Germany I wanted.

Prior to going to Germany, I had to complete OBLC (basic training) in San Antonio as I wasn’t able to do so between my 1st and 2nd year of medical school. They no longer offer waivers for this course. OBLC was a complete waste of time considering I had been in the army for 3 years and most of the information is geared toward medical platoon leaders, not doctors. If you have the opportunity (most do) to take the shorter course during medical school, you should.  You will learn the military finds interesting ways to waste your time. Also never, ever believe anything anyone tells you about your career. Get EVERYTHING in writing. I have had several disappointments because I was misled by others along the way.

In Germany, I took over doing primary care and procedures. Military medicine takes some getting used to but once you get it down it can be pretty enjoyable. About 6 months after I arrived in Germany I got orders to deploy with a unit in Germany (2/2 SCR) to Afghanistan. If possible they will have you attend their 3-4 week train-up held in Germany, Louisiana, or California about 3 months prior to your deployment. As a physician, you are required to report to your unit (usually not located at the same base as you) about a month prior to your deployment and they can keep you for up to 3 months after. Most units, however, release you within two weeks.  Which means that your deployment is actually longer than the rest of your unit’s is.   Also, numerous physicians failed to receive payment for housing during the pre/post deployment periods which can be financially quite taxing.   If you are joining the Army you can count on deploying for 9 months within one year of graduation from residency. [Everything in this paragraph is Army-specific and your experience will vary in the other services. One nice thing about deployment is pay. Most of your pay (except bonuses) is tax-free while deployed and you receive several other pays like family separation pay ($250/mo), hazardous location pay ($100/mo), combat pay ($225/mo) and per diem ($3.50/day). In all it means that while deployed you make about $1600 more a month after taxes. [Of course, if you were moonlighting prior to deployment, your pay may actually go down while deployed.-ed]

17. Would I Do it Again? 

That’s a really hard decision to make. There are a lot of variables.

First, there is the money. The scholarship is worth twice what it was when I joined (we had no bonus and were paid $1000 less a month). The military will pay you at least $20,000 more a year in residency than the civilian side which is a really nice feature [While the military still pays more, the difference is decreasing as residency pay has been climbing the last few years.-ed]   However, they will pay you at least $35,000 less (as a family doctor) per year then you would make as a civilian.   That’s over $120,000 in lost pay. However, you add in the scholarship value and the extra pay in residency and you do come out significantly ahead IF YOU DO PRIMARY CARE.

Second is lifestyle.  I would likely have never had the opportunity to live in Hawaii or Germany had I not joined.  I have visited a lot of Europe for very cheap due to living there.  The Army has great free healthcare and provides a lot of discounts on many things.  That being said, if you were unhappy with your job, your co-workers, or your lifestyle in the civilian side, you could pack up and move.  That is not an option in the military.  I likely would not be happy with the lifestyle the army has provided me if I had done my residency in Georgia (my last choice) and had my first assignment in Fort Polk (middle of nowhere Louisiana). You don’t always have a lot of control over this.

Dr. Ellenbecker enjoying his time NOT in Afghanistan

Third, you should consider family.  For the most part, the Army provides fairly well for families but that doesn’t make it easy.  It is very hard for spouses to find jobs overseas or to uproot their job or educational objectives every few years.  For me, family is the most important thing.  My wife and I had our first child shortly after we arrived in Germany and I had to leave him for a year when he was 8 months old.  That was really hard.  We added a little girl to the family after I left the Army and it just cemented in what I missed out on.  I have no desire to leave my wife and child again for this length of time.   Deployments are long and difficult. We weathered the storm but not everyone does.  Civilians get paid A LOT more to do the same job active duty does down range.  I was once asked what it would take to do another year in Afghanistan and I said $500,000.  The Army isn’t going to pay that.

Finally, think about what you want in a career.   Army medicine was for the most part enjoyable for me, but it isn’t for everyone.   Army politics and posturing is a constant battle.  I have no doubt that I will enjoy my medical career more outside the military then I have inside the military simply due to not having to deal with Army BS.  In addition and possibly most importantly, one needs to realize that you have ZERO control over your career until you make Lt. Col.  I had a very good friend who upon graduation was stationed at Fort Drum (a horrid location).  For 4 months he worked 5 days a week in a clinic setting and a 12 hour (day or night) every other weekend in urgent care.  He was not paid more for the extra hours and he was not compensated with off time.  He was then promptly deployed to a forward outpost where he essentially provided sick call to about 60 soldiers for a year.  Not exactly a good way to start one’s career (skill erosion).  Upon return from deployment, he was assigned to an admin position and did patient care about 1 day a week for the next 18 months despite asking to move repeatedly.  The army had no interest in him maintaining his skills.  It’s sad too, as had he had a better early career he probably would have stayed in the military.

Would I do it all again?  I don’t know.  For today’s offer probably.  Given the offer I had, probably not.  The bonus would have helped a lot and my stipend was so low I had to take additional loans just to make rent which I wouldn’t have had to do now.  I enjoyed my time, but I am happy to be out as well.

What do you think? Did you take the HPSP Scholarship? Were you glad or were you disappointed? Would you do it again? Did you consider it and turn it down? Why or why not? Comment below!

This new two year clinical program is incorporated in the CAMPEP accredited residency in Radiation Oncology Physics. The program is designed for physicists, educated to the Ph.D. level in medical physics, who are intending to pursue a career which includes leadership positions in academic radiation treatment centres. The Diploma has two basic components; a practica requirement, and a course requirement. Residents are required to successfully complete the eight half courses listed below. MDPH 711 and 721 run over the first year of the program and MDPH 712 and 722 over the second year. MDPH 731 and 741 are scheduled by mutual consent within the two years of the clinical program. The Business courses are scheduled by the Haskayne School of Business.

MDPH 711 - Clinical Competency 1

This course extends over the first year of the diploma program and consists of rotations through areas of clinical physics under the supervision of adjunct faculty. Objectives are established at the commencement of the clinical rotations comprising this course. Student performance is evaluated by the course mentors and by oral examinations.

MDPH 712 - Clinical Competency 2

This course extends over the second year of the diploma program and consists of rotations through more complex areas of clinical physics under the supervision of adjunct faculty. Objectives are established at the commencement of the clinical rotations comprising this course. Student performance is evaluated by the course mentors and by oral examinations.
(Prerequisite: MDPH 711)

MDPH 721 - Clinical Projects 1

Two to three clinical projects are completed during this course extending over the first year of the program. Projects, which generally have immediate clinical relevance, have clearly defined objectives established by mutual agreement between the student, project supervisor and program director. The projects culminate in written reports and oral presentations. Student performance is evaluated against the objectives established at the commencement of each project.

MDPH 722 - Clinical Projects 2

Two to three clinical projects are completed during this course extending over the second of the program. Projects, which generally have immediate clinical relevance, have clearly defined objectives established by mutual agreement between the student, project supervisor and program director. The projects culminate in written reports and oral presentations. Student performance is evaluated against the objectives established at the commencement of each project.
(Prerequisite: MDPH 721)

MDPH 731 - Radiation Oncology Physics Tutorials

This course requires the student to prepare written answers to 120 pre-set questions published by the Canadian College of Physicists in Medicine as part of the certification process in Radiation Oncology Physics. The course is conducted in a tutorial setting and the students are evaluated on the basis of their answers to a subset of the questions.

MDPH 741 - Treatment Planning

This course has three components and is spread over the two years of the program to ensure that the student’s increasing knowledge can be consolidated into a thorough understanding of radiation oncology physics. The first component is the observation of simulation and localization under the supervision of a radiation oncologist. The second component is an in-depth study of the physics behind the treatment planning of the main tumour sites. This component utilizes a web based tool and is led by adjunct faculty. The final component involves following ten patients through the entire radiation therapy process from immobilization through localization, treatment planning, treatment delivery to verification. The students’ progress is evaluated throughout the course with regular feedback to the student.

The following two course are offered by the Haskayne School of Business

HROD 793 - Business Negotiations

The major concepts and theories of negotiation; the dynamics of interpersonal and inter-group conflict; analysis of negotiation strategies and individuals styles. Application to a broad range of business negotiations. Use of simulations and written assignments.

HROD 789.02 (S01) Optimizing Team Dynamics

This course is designed for students who are or who will be leading or working in teams in industries where success depends on effective teamwork and the ability of team members to integrate disparate knowledge bases. This includes those who will participate in or lead R and D teams, multidisciplinary teams (e.g., in the energy industry or medicine), teams in knowledgebased industries or that develop new technology, and/or entrepreneurial/new venture teams.

Practica in Radiation Therapy Planning and Diagnostic Imaging

The objective of the two radiotherapy planning practica is to develop hands-on skills and expertise in 3D conformal radiation therapy, brachytherapy, intensity modulated radiation therapy, image guided radiation therapy and stereotactic radiotherapy for various tumor sites. Similarly, another two practica are dedicated to developing an in-depth understanding of quality control equipment and procedures in diagnostic radiological imaging, mammography, PET/SPECT, nuclear medicine and magnetic resonance imaging. The resident works closely with a senior dosimetrist and Imaging Physicist to perform routine procedures during the summer months.

Registration in the Diploma Program requires an appointment as an Associate Medical Physicist with the Alberta Health Services at the Tom Baker Cancer Centre. Thus registration in this program is limited to one to two at any one time depending on the availability of funding. Positions are advertised when available.

Successful applicants to this Post-doctoral Diploma Program will usually have completed a doctoral degree in a CAMPEP accredited graduate program or equivalent. Individuals who do not meet this expectation will be required to address any deficiencies through completion of the necessary graduate courses. In such situations the length of the training program will be extended appropriately.

When research funding is available in addition to funding for an Associate Medical Physicist position the program will be extended to accommodate two full years of clinical training as well as the research component.

For further information you are invited to contact:

Alana Hudson, M.Sc., FCCPM
alana.hudson@albertahealthservices.ca
Residency Program Coordinator
Medical Physics, Tom Baker Cancer Centre.

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