By Dr. Jim Dahle, WCI FounderMost long-term readers know I spent my first four years out of residency as a military physician. I was an Air Force officer (separated as a major), but I worked shifts in both Air Force and Navy hospitals (the Navy was much more impressed when I introduced myself as “Captain Dahle”). I took care of soldiers, airmen, sailors, and Marines. I even took care of SEALs, although their descriptions of how they got injured were always extremely vague.
I practiced medicine on four continents, ran a hospital department, served on the medical executive committee, and functioned as the EMS director. I could direct the assembly of a tent hospital in a matter of hours, and, at times, I knew the most about my specialty and several others (ophtho, ENT) of any military member in an entire country. Those who have read what I have written about military medicine might conclude that I am the most anti-military doctor on the planet. That is not true at all. When I am asked for my honest opinion, I tell people that the bad just barely outweighed the good. I would not do it again, but I had lots of great experiences. Nothing really bad that could have happened to me ever actually happened.
I managed to skate through all but one of the bad things that can occur in military medicine. Nobody ever took a shot at me. I managed to get exactly what I wanted out of the Military Match (and the civilian match). My deployments were shorter and safer than those of any other military emergency doctor I know. One of my two kids even knew who I was when I came home. I put up with my share of bureaucratic nonsense and came home a lot more often complaining about my job than I do now, but the only really bad thing that ever happened to me was my assignment.
When I came out of residency, I was told to make a rank list of the 16 or so places that the Air Force sent emergency docs. My wife and I stewed over it like a residency rank list, and after much blood, sweat, and tears, I submitted it. Then, we were given our last choice. It kind of made us wonder why we bothered making the list since it obviously had no effect on our assignment. At the last minute, we were offered a new assignment, one where there wasn't even an emergency doc (and so, it wasn't on our list at all). Given the alternative, it seemed like a good idea to take it (which we did in about 10 seconds as my wife yelled, “Take it! Take it!,” while I was covering the mouthpiece on the phone). We ended up a long way from family and even further from the mountains. Oh well. I took up disc golf and gave up climbing for a while (which serendipitously allowed me to replace a very expensive term life insurance policy).
The military and its HPSP “Scholarship” have their problems, but in today's post, I'd like to point out some really awesome things about military medicine.
The Benefits of Being a Military Doctor
#1 Quality of the People I Served With
The best part of the military was, without a doubt, the people. I served with my co-workers, and I served with my patients. The vast majority of the people I worked with and the people I worked on had made a commitment to serve their country and each other. They were absolutely a pleasure to be around. They were truly the salt of the earth. Now, I'm in a great partnership and have some great co-workers. I even have some great patients. But imagine an ER where all the patients are required to maintain a healthy weight, work out three times a week, work hard for a living, and get drug-screened regularly. It's pretty cool. But since they don't actually get non-viral illnesses very often, the medicine itself was a little boring.
More information here:
10 Reasons to Thank Military Docs for Their Service
#2 Camaraderie
In the military, it not only feels like it is you against our nation's enemies, but it also feels like it is you against “the man.” It isn't that any of our commanders, right up to the commander in chief, really wanted anything bad for us. It was simply that the needs of the military did not always coincide with our personal and career desires. But that opposition really makes for a great sense of camaraderie, like we're all in this together. You have a little bit of that in residency but precious little of it in a community hospital.
#3 No Uninsured
Did I mention that everyone you see has insurance? While wait times are sometimes longer than you would like (the Naval hospital I worked at scheduled MRIs 24/7, even at 2 or 3 in the morning every night of the week), nobody has to pass on needed care due to a lack of ability to pay for it. I don't think I saw a dental pain patient in four years. Amazing!
#4 Everyone Has Someone
Likewise, everybody has someone assigned to take care of them. Some patients in a civilian emergency department have no one they can call to come get them and take care of them. But everybody in the military has a first sergeant and a commander. They may not want me to call them, but I could. No sitting around waiting to sober up in my ED.
#5 Get to See the Price of Meds
The military electronic medical record had its issues. But it also had a really cool feature. When you put a prescription into it, it would tell you how much the medication cost the military on a per pill basis. Most pills were less than 10 cents, and $1 a pill was a really high price. It would be pretty awesome to have that kind of transparency in our civilian system, not to mention those prices!
More information here:
How Much Do Military Physicians Make?
#6 Security
One of the worst parts about practicing emergency medicine is that you fear for your physical safety. Just about anyone can get into our “weapons-free” ED with a gun and wipe out the whole place because they're mad they didn't get a dozen Percocets. So, what does the hospital do? It gives you an unarmed “guard” (who may very well qualify for Social Security benefits) to keep the place secure. The response time for the police ranges between 3-4 minutes (ask me how I know).
In the military, I NEVER feared a patient would hurt me. They would have had to get past a guard armed with an M-16 to get to me, and if they started acting up (or ran off when they weren't supposed to), I could call an entire company of heavily armed military police officers to ensure compliance with my treatment plan. Those guys loved nothing better than to run down an escapee. There was no way a patient I didn't want to leave the ED was going to make it off base. That was the most fun the Security Forces had all week.
#7 Guaranteed Debt-Free Date
Let's move into some of the more financial topics related to military service. I keep running into these docs who are planning to pay off their student loans over five, seven, 10, or even 15 years. My “student loans” were paid off in four years, guaranteed. Not a day less but not a day more either. If you can't get rid of your student loans within four years while living a “military doctor lifestyle,” maybe you should take a closer look at serving.
#8 Gradually Increasing Income
I criss-cross this country preaching to students, residents, and attendings the merits of living like a resident and growing into your income as slowly as you can. But I confess that I had an advantage that many of them will never have. I was FORCED to grow gradually into my attending income. We've always saved, and as an attending, I always saved a lot. But it's a little easier not to spend $300,000 as a brand-new attending when you're getting paid $120,000 as a brand-new attending. I sometimes wonder how much of our financial success I can attribute to the fact that we had many small raises instead of one big one, like most emergency docs.
#9 The TSP and the SDP
Military members have two really cool investment programs available to them. The first is the Thrift Savings Plan, which is one of the lowest-cost 401(k) programs in the country. It is comprised entirely of high-quality index funds with rock-bottom expense ratios. It even has a unique investment, the G Fund, not available anywhere else which provides one of the few “free lunches” in investing—bond yields with money market stability. The TSP is so good that I've kept it since separating, and I actually roll more money into it when I get a chance. It's even better now that it has a Roth option. The second really cool program is the “Savings Deposit Program.” When you deploy and for three months afterward, you can put up to $10,000 total into this account and earn a guaranteed annualized 10% on it. I wish I could find more guaranteed 10% returns out there. After I left the military, the Department of Defense (DoD) put in place a new retirement system, known as the Blended Retirement System (BRS), that took effect on January 1, 2018.
More information here:
A Pre-Deployment Financial Checklist for Military Physicians
#10 Allowances
The best financial advantage for military members is the fact that a large chunk of their pay is tax-free in the form of a Basic Allowance for Subsistence (BAS) and, more importantly, a Basic Allowance for Housing (BAH). In addition, many of the “special doctors' pay” don't require the payment of payroll taxes. While deployed, a big chunk of your basic pay is also completely income tax-free. But wait, there's more. While in the military, you can usually declare your state of residency as one of the seven states without an income tax—or at least one that doesn't tax your military paychecks.
All this adds up to a ridiculously low effective tax rate on your income. In fact, one year in which I was deployed for the last four months of the year, I had an effective tax rate (federal, state, and payroll) of under 5% on a six-figure income. I won't see that again in my lifetime.
And there you have it, the top 10 things I loved about being a military doctor.
What do you think? Have you served or are you currently serving in the military? What do you love about it? Would you do it again?
[This updated post was originally published in 2017.]
Nice list, and agree (except that TSP, or for that matter any tax-deferred savings options, weren’t available during my 8 years of active duty). Several items I’d add:
-The opportunity to serve the country. This was NOT why I accepted the HPSP scholarship, which was all about the Benjamins, but I grew into it.
-The chance to be stretched medically, e.g., running a base medical clinic immediately out of internship, and serving as an attending in the Navy’s busiest overseas ED as a GMO (sorry to make you cringe, Jim).
-Having the opportunity to live (off base) in Japan
-Being paid as an attending during fellowship
-Serving on the front lines of a war with a Marine infantry battalion. This one is a mixed bag, but certainly provided lots of stories to tell over the years.
Would I do it all over again? Tough call . . .
In my navy residency we hashed out the 13 post training assignments amongst ourselves, thus avoiding any real or imagined sandbagging by the detailer. I got an overseas operational assignment as a first choice, then spent a total of 9 out of 24 months on ship patrols in the Westpac. My family survived a direct hit by a Cat-5 typhoon unharmed, because the host country is smarter than Florida and has typhoon proofed concrete buildings. When I was home my kids got to travel everywhere during the school year, to include a summit on Mount Fuji after about 40 hours of leg conditioning. The DODEA school was top notch and didn’t get all flustered when kids “deployed” randomly for 10 days at a time. Overall it was many good experiences that could not be purchased with money. We simply got lucky and it could always be worse than getting the last choice for job assignments. We should always remember that our patients chose to be in harm’s way, and so we stepped up and followed right behind them.
Your last sentence says it all. Thanks!
Hard for me to advise- meeting my spouse, our frugal lifestyle, Tricare and soon Tricare for life making the choice to FIRE easy- all contribute to my current lifestyle. Add in getting to live 3 years in rural Germany and 4 years in the UK (first on my service and his, second on his service when I separated but continued as a military spouse) and our kids getting overseas time and I am pretty glad. However I lucked out- when I was breastfeeding our boss asked us to choose which one of us to deploy (and he took the hit), and I never deployed in my 7 years service. And a negative- which I certainly may have experienced in civilian life but would have had better alternatives to having to accept it- was marked sexism and harassment by some of my residency attendings (worse because I arrived there following spouse when he got moved- much better situation at my PGY1 & 2 program).
And Jim you left off another risk- death and disability from service. Rarer for docs but a residency mate and a helicopter exercise widowed his wife and orphaned his twins. Sometimes suspect PTSD in spouse from those deployments.
I chose HPSP because I feared I might want to opt out of medicine after I already owed thousands in loans, and HPSP gave me a 5 year track (internship plus 4 years) option if that occured, whereas med school loan payments would have tied me to a high paying medical job for 10+ years (or bankruptcy). Had I not, I might still be living in a higher cost of living area, still working to afford life there, happy or no probably but likely not enjoying what I now treasure.
As Jim says you certainly need to accept/ adapt to military life- those who didn’t were miserable the whole time. Risks of not getting residency immediately- as for poor JP, and really being mandated (in my time- early 90s) to accept military residency if offered, but also option for getting residency O/O/O after serving some GMO time you might not have received as a civilian, for putting in your time. Dunno if this is still a likely reward for GMO service especially now there are less GMO slots, and I did FP so not a benefit for me.
I did USAF, USUHS and a joint USAF/USA residency. My specialty had only 12 locations or so, and I didn’t even list Keesler – but I was sent there anyway. That was 2006 so the base and hospital were just starting recovery from Katrina the year before. I completely understand why Katie said “Take it” about the other base. In 2011 we were sent to your base even though they weren’t ready for my specialty yet – thank goodness the Navy took me in!
Lots of both good and bad about military medicine, USUHS, military residency and payback time. We never got to Europe, but we did go to Alaska. I don’t think my residency was that spectacular but I passed my boards first try and I’ve never had trouble holding my own with others trained at big name programs. I never had to deploy while friends in other specialties deployed multiple times during shorter commitments. It’s definitely not for everyone and has its issues and is surely not the way to go for high paying specialties. In primary care you can easily be making more in the military – but you’re in the military and all that comes with it.
Same year I started and yes, thank goodness the Navy took me in too! Not sure what specialty got you out of deployments in 2006-2011, but it certainly wasn’t EM!
Luckily worked out for me as I matched military residency for anesthesiology which was competitive at the time, but I didn’t realize how military match worked. Military decides how many seats for each specialty they need so can be competitive and difficult to get a desired specialty/slot. Contrary to the HPSP med school recruiter who said, “No problem. You will get whichever specialty you want!” Know of some docs who just served their time after intern year as GMO and then did residency after completing payback years.
Still, looking back it was a positive experience. Especially related to the people you work with and those you serve. Actually has shaped the rest of my career–my following three civilian attending jobs (and only jobs so far) came to me through my Air Force colleagues I had served with.
Pathology. I had Army friends that went to Iraq and Navy friends that went to Afghanistan. The Air Force had us as non-deployable. It seemed like Anesthesia and EM were never at home.
Yea, that’s how it felt 2006-2010.
I think you nailed it. I would also add
#11: free health insurance
#12: the job variety
#13: working for a bigger mission
I’ve only worked as an Army physician, so I have no idea if these are worth the challenges of military medicine as compared to civilian medicine. I do know I’ve had the opportunity to take leadership positions early in my career that I likely wouldn’t have had in civilian medicine. Were they painful? At times yes, but they’ve made me a better leader and physician (or that’s what I tell myself). I’ve frequently come home and complained about my job, but I hope I’ve also learned something along the way.
I do appreciate the sense of purpose I get working in the Army.
I do daydream about the autonomy, control over my schedule, and sense of freedom that a civilian practice seems to offer! Overall the benefits have far outweighed the negatives, and that’s why we have stayed in thus far. I would do it again!
DoD MWR Libraries is one my favorite veteran benefits. It offers free accounts for vets and family members for OverDrive/Libby (E-Books, AudioBooks), Kanopy (indie films), Freegal (music), Consumer Reports, MorningStar Investing Center, Craftsy, Great Courses, O’Reilly (courses/e-book).
Via email: Love this article and might go as far as the baker’s dozen, a military doc probably 10 years before you we had three children in the military and they only cost me as much as my spouses meal, first child $4.25 a second child about $6 and the third one was about $7.50 and my 4th outside of the military was thousands of dollars even with good insurance. Next thing was TDY temporary duty orders as a resident and attending this was a wonderful way to continue my education and arrange short rotations with physicians around the country and overseas meetings often with per diem travel. Finally, military hops on airplanes with the family and some exciting trips strapped in the back of C-141.
I went to medical school on an Air Force scholarship, graduating in 1987 with no debt. I did my residency in pediatrics in the Air Force and got much more primary care experience than many university programs gave back then. I then did my payback years and left at the end of them. I strongly agree with points 1-3. Back in those days dependent children got their care from active duty pediatricians like me. I would also add that, due to some specific circumstances at my base, I got useful leadership experiences that no civilian could hope to get straight out of residency.