By Dr. Dustin Schuett, Guest Writer
Most military physicians know they are getting paid less than their civilian counterparts. Exactly how much less varies by specialty with some primary care physicians having the ability to make more than the median pay for their specialty at higher ranks. Surgeons and physicians in procedural specialties often are paid less than half of what their civilian colleagues in the same specialty make, and two-thirds of medical specialties don't even reach the 20th percentile of private sector pay for their specialty while they're in the military—even if they reach the rank of Captain/Colonel with 20+ years of time in the military.
Military Doctor Salary vs. Civilian Doctors
In January 2020, the Government Accountability Office (GAO) released a report on the total pay and incentives for military physicians and dentists. A significant focus of this report was aimed at evaluating the pay of military physicians and dentists by specialty at the ranks of O3 (Army or Air Force Captain/Navy Lieutenant), O4 (Major/Lieutenant Commander), O5 (Lieutenant Colonel/Commander), and O6 (Colonel/Captain) compared to their counterparts in the private sector. This report looked at 21 specialties (Anesthesiology, Cardiothoracic Surgery, Critical Care Medicine, Critical Care Trauma Surgery, Emergency Medicine, Family Practice, Internal Medicine, General Surgery, Infectious Disease, Neurosurgery, OB/GYN, Occupational Medicine, Ophthalmology, Orthopedic Surgery, Otolaryngology, Pediatrics, Psychiatry, Pulmonary Medicine, Diagnostic Radiology, Interventional Radiology, and Urology).
The GAO report provided a large amount of data of interest to military physicians and dentists. Notably, the report compared military physician pay at O3-O6 paygrades to civilian pay in those same 21 specialties. grouping pay into four groups: below 20th percentile, 20th percentile to the median, median to the 80th percentile, and over 80th percentile. The report used maximum compensation for a physician including BAH (Basic Allowance for Housing) with dependents, BAS (Basic Allowance for Subsistence), Board Certification Pay, and Incentive Pay on a four-year retention bonus, essentially the highest pay possible for a physician at each paygrade.
At the O3 paygrade, 100% of military specialties were paid below the 20th percentile of their civilian counterparts. At the O4 paygrade, four specialties (Family Practice, Internal Medicine, Pediatrics, and Psychiatry) were between the 20th percentile and the median for civilian pay, while 17 specialties remained below the 20th percentile of civilian pay.
At the O5 level, six specialties (Family Practice, Internal Medicine, Infectious Disease, Occupational Medicine, Pediatrics, and Psychiatry) were between the 20th percentile and the median for civilian pay, while 15 specialties remained below the 20th percentile of civilian pay.
At the O6 paygrade, two specialties (Infectious Disease and OB/GYN) were between the 20th percentile and the median for civilian pay. Five specialties (Family Practice, Internal Medicine, Occupational Medicine, Pediatrics, and Psychiatry) were between the median and 80th percentile for civilian pay, while 14 specialties remained below the 20th percentile of civilian pay.
In essence, physicians in 67% of specialties in military medicine could not reach even the 20th percentile of pay for their specialty, even if they made the rank of Captain/Colonel. For many specialties (Cardiothoracic Surgery, Critical Care Surgery, Neurosurgery, Orthopedic Surgery, and Radiology—both diagnostic and interventional), the gap between maximum military compensation and the 20th percentile of private sector compensation is more than $100,000 per year. An O6 military Neurosurgeon makes approximately $300,000 less than the 20th percentile and $500,000 less than the median private sector Neurosurgeon. For an Orthopedic Surgeon, those gaps are $125,000 and $300,000, respectively. These numbers are for non-fellowship trained surgeons, and these gaps increase for many fellowship-trained surgeons.
More information here:
Personal Finance for Military Physicians
Military Dentist Pay
For comparison among Dental specialties, military General Dentists, Oral Surgeons, and Pedodontists are at or above the 20th percentile of private sector pay from O3 on, and military General Dentists are above the median compensation for General Dentists at O5 and O6 paygrades. Military Orthodontists are below the 20th percentile for O3 and O4 and then rise to between the 20th percentile and the median at O5 and O6. Periodontists are below the 20th percentile as O3s and O4s. Endodontists are below the 20th percentile of private sector pay from O3 to O5.
Military Salary Increases Were Authorized but Not Incorporated
The 2021 National Defense Authorization Act (NDAA) authorized an increase in Physician Board certification pay from $6,000 per year to $15,000 per year as well as significant increases in the allowances for Incentive Pay (from a max of $100,000 to a max of $200,000 per year) and Retention Bonus (from a prior max of $75,000 to new max of $150,000). None of the three services (Navy, Army, and Air Force) incorporated these increases in their Fiscal Year (FY) 2021 medical special pay plans.
Despite being released over 13 months after the 2021 NDAA was signed, the FY 2022 Navy Physician Special Pay guidance did not incorporate these increases. In fact, Navy Physician incentive pay and board certification have not increased since 2016 for any specialty. For comparison, the cumulative US inflation rate over that time period has been approximately 22%.
Value of USUHS or HPSP
A counterargument can be made that those with a military obligation because the military paid for medical school (either via the Uniformed Services University of the Health Sciences, aka USUHS, or via a Health Professional Scholarship Program, aka HPSP contract) are better off because they graduated medical school debt-free.
The average graduating medical student in 2021 had $203,062 in debt, whereas physicians who attended medical school on a military contract (definitely not a scholarship) are typically debt-free or have significantly less debt. An orthopedic surgeon making a median civilian salary can pay off that debt in under six months using just the differential between their pay and the starting O3 Military Orthopedic surgeon pay. An HPSP contract takes four years, excluding training, to pay off; a USUHS contract takes seven years. Also, the pay differentials discussed here are much more relevant for military physicians who have completed their payback and are making the decision to stay in or get out of the military.
More information here:
Should I Stay or Should I Go? Financial Implications of Military Separation
How Much Is a Military Pension?
Another argument that could be made is that those who last 20 years on active duty earn a pension. The current pension for an O5 retiring after 20 years is about $48,400-$60,500 pretax depending on whether the physician’s retirement is under the newer Blended Retirement System or the legacy High-36 plan. While this is a significant amount and a guaranteed pension, it requires staying in the military, typically at a significantly lower-than-civilian payrate (for 67% of specialties) for that entire time, facing the uncertainty of deployments and PCS moves at an age where many physicians have families with growing kids who aren’t always thrilled about saying goodbye to their friends and changing schools every 2-3 years.
Military physicians do pay less in tax than their civilian counterparts for a number of reasons—foremost because they typically make a lot less money than their counterparts. Also, BAH is not taxable. This can be $45,000 per year (San Diego O4) or more depending on duty station and rank. For those at a 30% marginal tax rate, this is a $13,500 tax savings per year. Keep in mind that BAH was included in the GAO calculations of military compensation discussed above. Saving $13,500 a year in taxes is nice, but that is far less than the difference between military pay and civilian pay for nearly all physicians, especially those not at the O6 paygrade.
Many questions loom for the FY2023 Military Physician Special Pay Guidance. Will Orthopedic Surgeons and other surgical/procedural specialists pay get closer to civilian compensation, or will they remain well below the 20th percentile of private sector pay? Will any medical specialty pay touch the 20th percentile of private sector pay at the rank of O3? Will more than six specialties reach the 20th percentile by O5 or more than seven by O6?
The answers to these questions will likely continue to have significant implications on the stay-in-or-get-out decision for many active-duty physicians. It certainly has for me. As much as I have enjoyed the people I work with in the Navy and the patients I get to treat, it is hard to justify doing the same amount of work or more while getting paid about one-third of the mean civilian orthopedic surgeon pay.
Disclaimer: I am a military service member or employee of the US Government. This work was prepared as part of my official duties. Title 17, U.S.C., §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, U.S.C., §101 defines US Government work as a work prepared by a military Service member or employee of the US Government as part of that person’s official duties. The views expressed are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.
If you were a military doc, did you feel like you were underpaid? Did that affect whether you stayed in the military? Was the military paying for medical school worth the below-average salaries? Comment below!
[Editor's Note: Dr. Dustin Schuett, DO, CDR Medical Corps, US Navy, is an adult reconstruction fellowship-trained orthopedic surgeon currently serving in the US Navy in San Diego. This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]
Well written! As a USUHS grad I was almost 41 before I was able to complete my commitment and enter civilian practice. When I left as an 04 my pay was roughly 25% of what I make now as an IM hospitalist (admittedly I add about 7 days of locums to my regular full time work monthly). Making that little for that long has a clearly negative impact on the ability to save for college, invest for retirement and live comfortably in the face of life’s constant budgetary surprises. While I value the experience I had in the military, looking back I struggle to recommend it to up and coming young docs.
I often run into docs who reached millionaire status faster than we did (7 years out of residency.) Generally, it’s not because they managed their money any better than we did. They simply got paid more because I was making $120K in the military for those first four years (while working harder than they were). I once calculated that I came out $180,000 behind for going the HPSP route. The numbers will be different for everyone (and some docs will come out ahead) but one should at least be aware of what it is costing them to do some military service as they make the decision to do so.
Completely agree. I’m at 14 years in and I’m closer to $1.4 million behind where I would be had I not done HPSP.
Thanks Josh for your comment and your service.
Thank you for posting about this. In my surgical subspecialty, I’m probably going to be about a million dollars behind my colleagues after my 4 years of service. I haven’t calculated that to the dollar but my medical school tuition was about 25k/year and my annual attending salary deficit is conservatively 2-500,000.
When you factor in the possibility of deployment and inevitable career limitations the military places on physicians (limited fellowship choices, residency options, etc) one can appreciate why the military simply cannot retain its physician talent.
I chose military medicine because I wanted to serve and so I don’t regret my choice, but that pay disparity is unacceptable if the goal is to recruit and retain excellent physicians.
I once ran the numbers and figured I came out about $180K behind for serving. Sounds like you made a much bigger sacrifice than I did. Thank you!
Somehow I wasn’t aware of the GAO report. I usually see pay discussed as a fraction of the median published in places like medscape. Seeing it as a percentile is eye opening, especially when they’re already including a retention bonus.
The other counterargument I would have included is that we do make more as students/residents/fellows than our civilian counterparts. If you include HPSP stipend, scholarship value, and pay differential in residency, on a 4 year HPSP it makes things a little better, but not much. As you pointed out though, that’s more useful as a recruiting than a retention tool.
Have you looked at the new VA HPSP / what VA pay is like compared to other civilians? Their scholarship stipend is less than military, but it overall looks/sounds like probably a better deal.
KFM,
Thank you. We definitely make more as residents/fellows but that cumulative difference is more than made up in the first year in practice by the differential in pay for most specialties.
Haven’t looked at the VA HPSP. The National Health Service Corps scholarship has always been a better contract from a financial perspective if you want primary care/OB than HPSP
Retired military physician here. No doubt we were underpaid compared to civilian counterparts (I was a surgeon). Looking at a straight salary percentile comparison might be a little misleading though. There are many military discounts one can get that can help over time. The 10%% at Home Depot and the 10-15% at many restaurants adds up over the years (including now as a veteran) . We also went to many theme parks for free or for very discounted rates when my children were young. The ability to transfer GI bill benefits to your children is a large benefit too. We directly saved well over $200k with this and most of our children’s schools continued favorable tuition benefits just for using GI benefits at the school. This all helped even though we were paid a lot less but it would be hard to specifically quantify this difference.
Overall, I enjoyed my military medical career and would not have traded it for a higher income. The time I have spent in civilian medicine after the military has paid better but has been far less enjoyable. I do recommend considering military service for aspiring doctors but only if they have an interest in military service. Doing it only for a scholarship generally leads to discontent and unhappiness.
Thanks to the author and WCI for this intriguing post!
Thank you Investor Introvert for your comments and your service!
The discounts are nice but you’d have to spend a lot of money at Home Depot or Chili’s to make up the pay difference 🤣
The current max GI bill benefit is $25,000/yr. How did you manage to save $200,000? Any tricks for those of us with transferred GI bills to our kids to maximize the benefits?
Your point about only considering the contract if one wants to serve in the military is very true.
I’ve enjoyed a lot of my 14 yr career so far but each year becomes harder and harder to enjoy and harder to provide the best care possible for my patients!
Two of my children went to the University of Michigan for engineering. Michigan (like many schools) will keep the tuition at the in-state rate regardless of residency if you use the GI bill to pay their tuition and exhaust their benefits. So we saved around $100k each just for the two of them and we used it from some of our other children too. Now, would they have gone to Michigan if not for that- not sure, but it really helped them go to their first choice school.
Agree – you cannot make up the difference with discounts but it helps. We went to Busch gardens (family of 7) totally free at least a dozen times and the discounted Disney tickets from shades of green we used several times saved us a bundle. No way it makes up the difference up fully but you can live a life that would cost you more than actually make.
It was not easy but totally worth it to get to 20 years and secure the pension. Again, I have made way more money in my post-military retirement career but it has been far less enjoyable. Enjoy your military time!
You will look back upon it fondly in the future.
Good luck with your decisions!
I have to agree with this one. My daughter used my post 9/11 G.I. Bill benefit to go to Duke University for four years. The yellow ribbon makes up the difference and we easily saved more than 200,000. The VA who administer the post 9/11 G.I. Bill were also very meticulous about the number of days that classes were in session at Duke. After four years she still had a couple of months that I put towards her masters degree.
I also would put forth that the opportunity to live and work in Germany for three years, Hawaii for four years, and in Washington DC while not paying Maryland or Virginia or DC state income tax helps to make up for it. But really I stayed in for the amazing adventures and the ability to live in wonderful different places and still practice my craft.
Family of 7…using the DeCA published number of ~30% savings (YMMV) from using the commissary, I average about another $17k per year just from that.
That 30% number is bunk. Some stuff was cheaper at the commissary, some wasn’t, some just wasn’t available there.
I agree with WCI, the 30% number is way off the mark. Some things are cheaper at the commissary than other grocery stores, but overall its pretty close to even and when you add on being guilted into tipping baggers maybe even more expensive to shop the commissary.
Plus the boxes are so small there. I’m pretty sure a lot of the stuff we were buying was cheaper at Costco pound for pound.
Bravo to the men and women who made the decision to serve knowing it wasn’t just about income but about service as well.
Dave,
Unfortunately most of them/us signed up before we knew there was a difference or how big that difference is/was!
I was an HPSP supported student and completed training and payback. I was from a less than advantaged background and was quite happy to have the support during school and be debt free. I went to a state school and when I compared tuition with my peers in the military who went to the “big named” schools, I knew the military got a good ROI with me.
During my active duty time, I knew I was paid less, but at the time, thought I had what I needed and enjoyed the environment. We occasionally had to use locum coverage in the EDs (late 1980s) and we were amazed when we learned their salaries when working side by side.
After my active duty time, I continued in the reserve component and eventually retired as a senior officer. As an aside, I got to travel quite a bit in the reserve capacity and was a “participant” in events during the 2000s.
Now as almost fully retired physician, I enjoy a nice “annuity” from my military service which provides part of my “base” of retirement income. Another benefit that many forget is medical insurance provided by Tricare. It is almost free to me (and my spouse) and transitions to secondary coverage when one goes to Medicare. It also covers medications (in place of Medicare part D, another cost savings).
The military is not for everyone. There is the bureaucracy, loss of some life control in addition to some rare instances of danger. It can be rewarding and self fulfilling. I have no regrets. The combination of active and reserve service can allow for both military service and financial benefit of the civilian sector (easier in EM with schedule flexibility).
There is a way to serve your country, experience military life, and make civilian pay at the same time and I did that for 10 years.
My entire time was in the Air Force Reserves and the Air National Guard.
The only deployments I did were all domestic and lasted two weeks or less. I had small children the entire time.
I was able to experience the best things of the military for myself, which were military aviation including flying in the formidable F16 and meeting good doctors who are very dedicated to what they did in multiple specialties.
The camaraderie lasts to this day. It continues with a group of prior military fighter pilots with who I fly formation and charitable flights on a weekly basis. As a pilot/doctor, I keep current and safe flying with excellent mentors which I could have never found as a civilian-only aviator.
I got to learn things that could help me in real world challenges to include water survival and jungle survival…with a hint of how it sucks to get captured.
I got two incentive bonuses to total $150,000 over this time.
So what was not great? I was on call 12 weekends a month for my regular job and did at least 10 to 12 weekends a month of traditional reserves/guard duty.
+2 weeks of annual tour which cut into my vacation time.
This was all well and good but started to wear on me overtime and after 10 years, I had had enough. I could not do another day, let alone 10 more to retire.
I separated with honors and awards and a lot of appreciation from the guys and gals I worked with, and sailed into the sunset with great memories.
I would recommend considering this option if you don’t want to kill your income for years.
What I never loved and will never miss is the expected government bureaucracy, red tape, and sometimes poorly considered decisions coming from up top. The inefficiency is often jarring compared to private practice.
The pay is not what you would make in locums but then again, but it paid for my hangar where I house my small plane and then some, so it was significant enough.
I entered as a major since I got time for residency and fellowship and left as a lieutenant colonel. And when I count up every single day I actually was in uniform, it was probably less than 365 days.
From my point of view as a General Dentist, HPSP is the way to go. In 2008 a first year dental student was offered a $20,000 sign on bonus. This followed with all tuition, books and dental supplies paid for. In addition there was a $2,000 monthly stipend. This entailed year-for-year payback. Graduating after 4 years with no dental school debt is great. A general dentist is not ready to be immersed in a private practice at graduation. Most continue with a one year residency for further training.
So really a 3 year commitment, but still learning and typically surrounded by mentors from every specialty area. After the payback, this dentist is much better prepared for private practice. It’s really about the same in actual dollars. I’m retired military, but opted for military service after dental school as my “residency program”. I didn’t attend college with a military scholarship. I spent 3 years as an Army Dentist and then chose private practice. I stayed in the Reserves not for financial remuneration but because of satisfaction I got from taking care of soldiers. During my Reserve time there was no specialty pay. Now I think dentists receive $25K a year as a bonus. This is an added plus for future consideration if one is considering taking a scholarship. My contemporaries that joined the Dental Corps at the same time I did, and continued on to retire after 30 years of active duty get about a $110K/year retirement starting around 56 years of age. The bottom line, the civilian route is probably more lucrative, both are rewarding from a professional perspective, but whichever gives you more personal satisfaction is the way to go.
Just separated a little over a year ago from the dental corp and I tell people I would do it over again the same way in a heart beat but I am also so glad that I got out and am not looking back. I think the question between medical and dental in terms of betterment of financial outcomes is completely different because dental schools are by and far more expensive and if we are looking at the averages, general dentists don’t make near as much as physicians and specialties. It also depends on where you are attending school as well. I attended a very expensive dental school so doing the military for 3-4 years and then getting out to private sector was amazing for me financially and I feel like I am in a better place financially than my colleagues that graduated the same time but didn’t do the military.
I would also say that that depending on which branch and which base you are at that an argument could be made that the dentists are overpaid in relation to what they produce. A majority of the dentistry is being done by O-3’s and O-4’s then it tapers off dramatically from there because they take on admin roles rather than production roles. I saw a lot of career dentists in the military because they simply realized that they didn’t like doing it or weren’t any good at it so they stay in because they can still make a decent chunk of money doing admin, whereas if they separated they wouldn’t survive doing dentistry on the outside. Granted, that is a generalization, I had many wonderful mentors and excellent examples of what it meant to be a good practitioner during my time in active duty. Just had my share of too many military dentists bragging about how little dentistry they had to do.
In training, In Payback, Incompetent…..the three types of military docs?
Mostly true! In 16 yrs in the AF (USUHS, residency, payback) and 7 yrs in the USPHS I’ve definitely seen a lot O6’s that fit the incompetent description. But there are also many who stay for a variety of reasons and provide good care, especially in the lower paying specialties. The “incompetent” label almost always fit the direct accession docs who usually joined because they couldn’t get or keep a civilian job.
Jim-
You seem to love this offensive trope. I can’t speak to your experience. But I know plenty of incompetent older civilian docs. I know plenty of military docs who practice cutting edge medicine and get snapped up by prestigious training programs after they retire and go on to have great second careers.
Also- if a CIV doc goes into admin/leadership they are “making a career shift” or “treating their burnout”- but if a MIL doc does the same they are incompetent?
All I know is since retirement my CIV colleagues still call me to ask opinions on difficult cases and respect my training and work…
First, it’s a joke, so try to relax a bit.
Second, the joke is based on a stereotype, and as you know, there are always lots of exceptions to stereotypes.
However, there’s usually some truth behind a stereotype. There certainly was some to this in my experience. A certain percentage of docs who no longer owe time have not been practicing much, have not been seeing much acuity, are not efficient, or have quality issues. Or maybe they just love admin stuff or military stuff. They have legitimate concerns about making it in the civilian world. So they stay in. Is it everyone? Of course not. Maybe you’re the exception, I don’t know. The clinical skills of many (not all) of the O-5s, 0-6s, and 0-7s in admin/leadership were not well respected by their younger colleagues. I can tell you this. I worked in a military ED at a training center for 3+ years and didn’t intubate a patient in that ED. I didn’t even supervise an intubation. I deployed twice and didn’t do an intubation or chest tube on either deployment. That’s not exactly a recipe for skill maintenance. If I hadn’t been moonlighting in a trauma center, I wouldn’t have felt competent for civilian practice, and that’s after just four years. The extra money was nice, but that wasn’t the primary reason I was moonlighting. I can’t imagine what it would have been like after 12 or 20. I’m sure this aspect is highly specialty and location specific. There are consequences to caring primarily for a very healthy population.
White coat doc
I think I agree with most of what you wrote or observed
There are some fantastic clinicians and mentors in army dentistry but they tend to stay in the residencies bc of their love of teaching and selfless spirit
But outside of those I do think that a majority of people staying in to retirement are perhaps lacking in interpersonal or clinical skills it would take to be successful in the private sector
Some have just felt like they have so much time in after fulfilling their residency requirements that they gut it out to 20. Some want the joy of living overseas.
A lot, like you said, want a 200k + salary for pushing paper and going to meetings.
The inefficient practice style coupled with unreliable supply chain and onerous amount of required training seems to drive out a lot of people who are clinically driven.
The military has a lot of great things to offer but unfortunately not enough to retain a lot of people who have other legitimate options.
I think you’re right that many (but not all) of the exceptions tend to gravitate to residency programs. Certainly that’s where I met the exceptions I know. Now don’t get me wrong. I met some great administrators, but that’s not what we’re talking about here.
Well done, well researched, and agree with much of the discussion.
An individual conversation for sure, but would add that few other places can you practice medicine like this:
https://pubmed.ncbi.nlm.nih.gov/30535030/
Thank you Chuck! That CCATT program looks amazing!
As a now retired family physician I believe, disregarding deployments which are an adventure and interesting though risky, I got paid better for that long in my career in the military than I would have working the same number of hours. You could almost have a 40 to 60 hour work week instead of a 70 to 100. However there is a reason that most surgical specialty department chiefs in the military are majors; there are very few lieutenant colonels and kernels and generals in those specialties where they double or triple their pay by leaving. The doc who notes the military discounts etc and GI Bill has a point, and I sure wish since we are dual military with two kids that I had been eligible for the GI Bill before leaving the service 30 years ago. We only got to use four years of GI Bill for the 8 years of college we covered.
Also as above my husband really enjoyed learning to fly fighter jets etc. As I enjoyed jumping out of perfectly good airplanes. That saved us a million bucks we might have spent on getting those experiences as civilians.
Jenn,
Absolutely true for family practice and other primary care specialties. As detailed in my article, you can make around or more than median civilian pay in the military as a primary care physician.
The pay differential between a pediatrician and a fellowship trained neurosurgeon is $16,000/year. Until surgeons and specialists are paid closer to their civilian counterparts, they’ll continue leaving the military in droves at their first opportunity for triple their salary or more as you mentioned. I know numerous orthopaedic surgeons quadrupling their active duty pay in their first year as civilians without increasing their hours. No matter how much you love the military and the patients, its very hard to turn that down.
Tripling your salary will get you to FIRE a lot faster than a military pension ever will.
That last line was certainly my experience.
hoo boy forgot about Tricare! That’s really the reason we were able to FIRE, so I am pretty grateful to my husband for putting in his time and getting that benefit for us.
Like the author, I am a USUHS grad and orthopedic surgeon. Having spent 20 years in Navy medicine and 10 years in civilian medicine, I agree that the financial disparity is quite compelling. However, as far as the profession, there was no better population to hone my sports medicine skills and no better group of colleagues to work alongside than in military orthopedics. Civilian surgical practice is still a cut throat business and there is more administrative red tape than we encountered in the military. I aged more while hustling in 10 years of civilian practice than I did in 20 years in the military. As previously stated by others, military practice is not for everyone, but I am glad to have experienced both sides which, combined, has allowed me to FIRE at age 55.
“I aged more while hustling in 10 years of civilian practice than I did in 20 years in the military. ”
This right here is why I stayed past my commitment. Was fortunate to have several friends and mentors who shared similar experiences after leaving the military. I had the opportunity to leave the military a the 12 year point a few years back. Although civilian compensation was significantly more in my specialty, so was the workload and stress associated with it. We chose to keep the quality of life and benefits we’ve enjoyed so far in the military over higher pay.
Recognizing that I’ve had good luck so far with assignments, colleagues and leadership, stay busy enough to maintain my skills, am satisfied professionally … not the case for many… and my family has enjoyed moving around the country, also YMMV. Without those, absolutely agree that staying till 20 or leaving was not a financial decision, but we’re also well on our way to FI by 55.
This isn’t new information nor does creating a report/study going to change things. The system is working as designed. Most people leave after their commitment. The people who are “happiest” staying long term usually although not exclusively like the slower military pace of clinic/surgery or like command/unusual positions/locations, or are a non specialist who isn’t interested in trying to work at top speed, or has a family member who is not insurable. I believe somewhere in the high 90s percentage leave after commitment.
I was ROTC and HPSP and I’m glad I joined. I wear my Army scrub caps most days of the week. I joined at 17 . Didn’t know what I was doing. Glad I did it.
As a board certified Oral & Maxillofacial Surgeon I currently make around $160k as an active duty O-4 in the Army. Moonlighting around 4 days a month I make significantly more than that full time military salary, and that’s in a job that’s not coming close to fulfilling my full potential. That’s basic cases working 7:30-1:30, no call, no admin, no Army silliness. It would take only 38 days of moonlighting to match my Army salary for a full year. I’m not sure where this article got the data for dental from but while most dentists do okay in the military it’s laughable for oral surgeons, they are struggling to retain anyone.
How much is enough?
Zack,
The Dental numbers came from the Linked GAO report. Talking to several oral surgeon buddies, they echo your sentiment that the gap between military and civilian oral surgeon pay is cavernous!
Bev,
How much less than market value are you comfortable taking for your skills/work?
Bev,
How much more time should we work for the military compared to private sector for same pay. You can’t put a price on more time.
How much more time away from your family are you willing to put in for the same pay?
My husband is a 3rd year active duty fellow and we have an almost 700k net worth in a down market. USUHS allows you the ability to max out retirement accounts in med school. Purchased 2 homes with VA loan. $1200 per month daycare subsidy. GI bill transferred so one of our kid’s college tuitions is already paid for. Almost free healthcare. Making military “attending” pay as a fellow and significantly more as a resident. You can make a lot of progress if you have a good plan starting in medical school…
MC,
Depending on specialty, you can make a lot more progress on the civilian side saving similarly and buying homes with physician loans.
Definitely works best for military docs like you guys to have a strong plan and stick to it. Its typically in the post-fellowship years that the massive pay gaps become much more apparent.
Thanks for the nice article on military doc’s salaries compared to private practice physicians. I joined the Army Reserves my first year of medical school in 1983 and the primary reason was i needed the extra money to make my car payment. The second reason was i came from a family of veterans and also wanted to serve. I completed 23 years of service and 2 combat tours in Iraq as an orthopedic surgeon with a Hand Fellowship. I was activated in the middle of my practice in 2003 and then again in 2005 and it definitely affected my salary and overhead . It became the main reason i left my practice which was to pursue a different a practice opportunity. Like the comment from one of the other docs if you only do it just for the money(HPSP/STRAP) and other scholarships you might be disappointed with the commitment, deployments and decreased salary. I’m retired from the military and have a small pension but still practice and will have Tricare for Life. I’m glad i served and still had a good living !
I’m writing this reply from a tiny one man Army light fighter tent issued to me to sleep in while I complete my 2 week annual training as a member of the Army Reserves. Trust me when I tell you that no amount of money will make you feel good about sleeping on the ground in a tent smaller than my kids closets in chilly temperatures. But the reward for serving in the Army is so much more than a financial number. For reference I currently own my own practice as a civilian endodontist. Prior to this, I did 3 yr HPSP(graduated with little debt [50k] in 2008) and served for 12 years on Active Duty(AD) in the Army. I left AD(debt free and 750k net worth) and started my practice 2 years ago while continuing to serve via the Reserves. My last year on AD I made approx 200k as an O-4. My first year in civilian practice I more than tripled that income. But my memories, friendships, and experiences from AD and those I’m making now in the Reserves are priceless. I love what I do both working for myself and for the Army. Life is more than money and root canals and I am grateful for the opportunity to serve regardless of the financial trade off.
A lot of great comments. I am a Army 06 at 24 years of active duty, FP doc. I only did a 3 year HPSP scholarship and fully intended to get out after paying that back post residency. But it has a been one great job after another, and leadership opportunities have kept me in, most recently running Tripler Army Medical Center on Oahu. If I walk away in 2024, between the retirement pension and the VA, looking at approx 130K a year before I touch investments. Between the MHA and MBA the Army paid for me to receive from Baylor, along with a WCI and PoF education, sitting on plenty of investments (TSP, Roths, ETFs, real estate, etc) to retire very comfortably. I have looked at several sites to put a value on that pension, worth about $3 million, debatable on how you value it, but not bad. Concur with all other posts, military not for everyone, but it has been good for our family, lived in many great spots that we explored as a family, and missing Hawaii now that we are in DC.
Martdoc,
Sounds like it has worked out well for you and your family! Definitely tends to be less o a difference between civilian and military pay/lifestyle for FP/Peds/IM docs than surgeons.
We’ve had some great experiences, but the massive pay gap along with other administrative headaches are too much to ignore for us.
Pension for 20 year career is closer to $1.4-1.6m, 24yr O6 obviously much higher/more valuable.
I am at 19years of Active Duty as an Endodontist. Has my income been less than my peers the past decade? You bet! Have I regretted my decision? No way…the adventures of travel while living in different locations every 3 to 4 years in addition to a variety of Career opportunities has made the reduced annual income more palatable. Next summer I am eligible to retire at 46y/o and receive a pension of just shy of $6,000/month with future adjustments for inflation. It is challenging to put a value on defined benefit plans because to maximize the value requires living a long life. The military is still one of the only places where you can work for 20years and receive an inflation protected, passive income stream for an additional 50 years(if you live that long). There is a reason defined benefit plans are not available in many places; they have resulted in bankrupt companies due to the incredible expenses involved. When I put in the specifics of my situation in an immediate annuity calculator on the Fidelity website, it indicates that next summer I would have to give them a lump sum of approximately $1.6 mil in order to guarantee $6k/month passive income stream the rest of my life. The article above, does not accurately capture the hidden compensation contained in the military pension plan or the value of the medical benefits for life.
Dan,
Congrats on making a career of it!
Keep in mind the inflation adjustments don’t keep up with inflation in fact they’re not designed to which is why the CPIW and not the actual CPI is used, so every year you’re getting a little less than the year before when adjusted for actual inflation. For instance the 2022 COLA was 5.9% while the 2022 CPI was 8.6%. From 2010-2022, the total additive (percent per year added together) military pension COLA was 22.4% while the total additive CPI was 32.2%, essentially a 10% loss in value over 10 years.
A government guaranteed pension is great but the hidden losses in the military pension plan need to be accurately captured.
Interesting read. I did not realize the pay disparities were quite that great and are for sure one driving factor of people getting out of the military. I am about 3/4 of the way to retirement and I can only speak for the Navy, but I see the lack of leadership valuing physicians as a huge reason people are leaving my specialty. When our retention bonuses are cut, we do not feel valued. When our training pipelines cut in half, we do not feel valued. When entire communities are planned to be cut in half with no salient plan for how that will work, we do not feel valued. When we are told we could just be replaced by civilians with no money to hire those civilians, we realize that the plan is just to make the remainder of us “do more with less”. When a poor outcome happens from this lack of planning, all of the blame will be put directly on the physician not the system that has ultimately caused the issue. I already see this happening in the Navy and a large portion of divestitures are planned to happen in FY24 unless the NDAA pushes them out farther. Of course we will not know if they will or will not be pushed out until it is too late to hire civilians as our hiring process takes years. This lack of value and fear of existing in an organization that is only putting you and patients at jeopardy is driving people out in droves. The ability to make more in the civilian sector where jobs are plentiful everywhere is just icing on the cake.
My pay was exactly 10x less as a surgeon in the military during my HPSP time. Financially I could catchup later and I think everyone that is able to should serve their country for at least two years, just like it is required to do so in many other countries. It is great to say I was a veteran and I’m proud to have served our country. Financially of course it is not going to optimize the potential pay but it will carry a level of credibility and character that is irreplaceable.
Thank you all for this discussion and comments. I am one of those who decided to give Military Medicine a go before understanding what it was truly about. I come from a lower middle class family, came into med school already in debt from undergrad and grad school, and I really do enjoy the idea of serving those who serve (in spite of the red tape and whatnot), so it’s a win-win for me, for the most part.
I am a current OMS III and I am beginning to think about what I would like to do as a career. So far I think I will do alright as a doctor irrespective of my specialty (which, granted, is making it really difficult to choose one in particular). I understand that surgical specialties are much longer and some of them are Army-sponsored civilian only, in which case my payback time will double. In terms of finances, would it be more practical to pick a specialty that has a shorter number of residency years (preferably served at a military facility) and enter practice earlier? Or will the extension of my payback time not affect my pay overtime/my moving through the military ranks?
Also, I intend (so far) to retire in the military. Is there an advantage/disadvantage to choosing one specialty over another if one does not intend to leave once the commitment is done? And if somehow things change and I decide to leave, will one specialty/type be more beneficial (financially speaking) over another when in comes to returning to civilian practice?
I should add that I like the idea of being a surgeon, but I would like to have a full life experience with my family. I already like Family Medicine so far, and I know the GPs and Medical specialties have less tedious schedules than specialists/surgical specialties, but General Practice is not quite where I see myself. I was wondering if anyone took the financial aspect of things into consideration (in addition to time for extracurriculars) when considering a specialty, and if there was any advice you could share/ anything you might do differently if you could have.
Thanks in advance for any tips!!
A colleague calculated this for General Surgery:
6yr RB
– $118k annually
– IP rate increases from $52k to $85k
4yr RB
– $103k annually
– IP rate increases from $52k to $70k
The bonuses drop off pretty precipitately for less than 4yr ADSO.
For a mid-career 05 in this area, which would be the career point most would consider signing a 6yr RB. – It comes to about $330k/yr with base pay and BAH.
Given the pay for less hustle and Tricare insurance, this seems like a good deal. Is his math correct? Six years is a looong time to commit to but would get you to retirement too.
$330K/year? Seems pretty high, but surgeons are generally in pretty high demand in the military so I guess it’s possible. That’s almost 3X what the military ever paid me.
Confirming Army Gen Surgeon’s breakdown. Here is what the military pays me as an O5 over 14 years Anesthesiologist :
$107722 basic pay
$34416 BAH no tax
$3363 BAS no tax
$59000 IP
$125000 RB 6 YRS (signing next week)
$5000 Board Certification Pay
$9000 Variable Special Pay
$15000 Additional Special Pay
On the other hand my wife is a former military OMFS who felt it was certainly not worth the pay difference or work/life balance to stay in the military. She got out after 9 years (HPSP) and this year will make north of $400000 working an average of 6 days per month.
I really wish the military would fix these pay discrepancies. I’m finishing my first year of medical school, and a recruiter told me about HPSP. After doing the math and looking at many articles like this, I just can’t justify going into active-duty military service. And that’s with me looking to do some of the lowest-paying specialties (interests in psychiatry or internal medicine). I have some interest in radiology as well – where the pay difference would be very high.
Further, I’m terrified of doing HPSP and not matching into a military residency they want and being forced into being a “GMO”. This would put me nearly a million dollars behind civilian physicians that did match after my commitment (on top of the six hundred thousand or so loss for my contract time).
The tragedy is that I think I’d genuinely enjoy working for the military full-time. I suspect it would be the type of environment I’d stay in until retirement. I like the PCS, I like the bases, and I like the idea of deployments. If they would fix themselves I think they’d have a lot of really passionate people do whole careers in the military instead of jumping in and out to pay for school.
Can anyone comment on a few questions I have?
– I see there is a $500k+ accession bonus for many specialties. I assume this is not available to HPSP people who are already fulfilling a commitment. In this case, why would anyone ever do HPSP? This 500k is far beyond what they pay for in HPSP, and there’s no risk of being forced into a GMO position.
– I am interested in Reserve or Guard service (given that I can’t make the HPSP numbers add up), can someone outline all of the pay incentives in these components for physicians (or point me to a source to view this)? I can find drill pay and such but didn’t know if there were retention bonuses and yearly pay incentives for physicians. I’ve been told there is a $25k yearly incentive when you re-sign, and a loan repayment contract option at 40k/year, but don’t know much else for the typical year.
Good to know how it works before signing up, right?
At any rate, the military will still want you later after you’ve been trained. You can always go in then and likely get an accession bonus worth about what you would have gotten for HPSP. But no, an HPSP person doesn’t get that too. $500K isn’t all that far beyond what one could get for HPSP. Add it all up. Stipend x 48 months plus books plus fees plus tuition at an expensive medical school plus the time value of money. $500K is probably about right for many schools.
You can learn more about the Guard here:
https://www.whitecoatinvestor.com/army-national-guard-physicians/
Yes! It is very good to know. I’m grateful this site exists to help us consider all of our options.
I have read the article you linked multiple times – another great one!
I am interested in following closely to your ‘maximizing the benefits for the current medical student’ advice listed therein.
I’m still not sure if I would like to take MDSSP/STRAP for my remaining 3 years of school + 3 (depending) years of residency; or if I should wait and take retention bonuses.
As far as I know, the current rates for MDSSP/STRAP are 2400/month (28,800 annually, 172,800 over six years). This would carry a 9 year commitment (6 for medical school’s remaining 3 years, +3 for 3 years of residency). –as STRAP is reduced if taken in conjunction with equal MDSSP years.
Current retention rates for physicians are about 25k/year – so that would be 225k over six years if nothing changed.
On the surface, it would appear that retention bonuses would win out even if the amounts don’t increase by then. But the story is decidedly less cut and dry.
For one, I’d have significantly higher tax burdens by the time I graduate a residency. This would probably eliminate the ~50k upside and then some on its own. Additionally, one could theoretically invest some of the MDSSP/STRAP and have interest over that time period (though, this would admittedly be a low amount invested). In the same territory; the MDSSP/STRAP would offset potential high-interest loans for my living expenses.
The most concerning drawback (you mention this in the article) is losing the ability to “try out” the Guard – as you would have to fulfill that long commitment even if you didn’t like it.
I’m also wondering if you could change branches and serve out that commitment (say, for example, I was in the Air National Guard or Army National Guard, and then the Space Force finally gets its Guard – could I switch?) I suppose I’ll have to ask a recruiter about these finer points.
–One thing I’d really like to read about from you is a breakdown of working for the VA. I have spoken with the VA about their HPSP program and it seems a lot more palatable than the active duty military route. With close (ish) pays to the civilian world, federal retirement/benefits, lots of vacation time, etc. It is looking pretty appealing.
We’ll see if we can find a VA doc to write about their experience.
Does anyone have a formula they like for maximizing earnings as an Army surgical sub specialist (with a pretty lengthy commitment)?
The pay is kind of standardized, what kind of a formula were you hoping would help?
I’m thinking roughly 150-200K total annual income from the military including special pay, but that’s it without additional revenue streams or moonlighting. Maybe based on an example of someone who has done it successfully, are there other revenue streams that make sense uniquely for an active duty doc, maybe due to certain active duty benefits or day to day lower patient volume? Anything from certain real-estate “must-do’s” (possibly related to getting stationed in various places and buying property then renting it out after PCSing?) to special investment accounts to consulting or medical device inventorship.
I think another way of asking this is are there examples of active duty docs with side hustles that did very well, and maybe even helped them make close to their civilian counterparts? Thanks!
Lower volume. Ha ha. Only in some specialties. My military experience was definitely never a “lower volume” one.
I don’t think long distance landlording is a particularly great side hustle, but lots of military members have certainly tried THAT.
The main “side hustle” military docs do is moonlight in the civilian world practicing their specialty. I did that and definitely increased my income dramatically.