By Dr. Charles Patterson, PCP and Military Medicine Physician, WCI Columnist
Medical school is expensive. If this comes as a newsflash, then you are either new to your journey in medicine or are financially illiterate. In either case, you need to develop a plan for how you are going to pay for it. Scholarships abound, but in this article, I am going to focus on one in particular: The Health Professions Scholarship Program, or HPSP.
What Is the Health Professions Scholarship Program (HPSP)?
While the word “scholarship” is in the name, let’s first make one thing clear: this is more of a contract than it is a scholarship. In return for tuition, the recipient will owe time in service as a commissioned officer in the Army, Navy, or Air Force. So when naive folks point out that you are graduating medical school debt-free, you can rightfully respond that there is no such thing as a free lunch (or medical education) and that the military will always get its due. If the person pointing this out is a recruiter, tread carefully and realize that their intentions are to sell you on the program. They can be great resources, but it would be wise to consider their bias.
With that being said, the HPSP is a fabulous program and one that opens the door to some incredible opportunities. For a select few medical students, this is an excellent option. But how do you know if you are one of them? Should you join the military to pay for medical school?
What to Consider Before Applying for the HPSP Program
Here are five basic questions that you should ask yourself when considering the HPSP.
#1 Do You Want to Be an Officer?
If the answer is “no” or “I don’t know” or, after careful thought, is anything other than “yes”, then the HPSP is not for you. This is a hard stop: do not pass go, do not collect the incentive bonus.
Physicians in the military are simultaneously and equally entrusted (encumbered or privileged) with the profession of arms. This entails, first and foremost, a solemn oath to the Constitution of the United States. In the years of obligatory service, it will also mean taking care of young service folk (think adolescent medicine) and a generally healthy population.
Beyond that, there are the shenanigans: mandatory briefings that waste your time, annual computer-based training that wastes your time, and a host of other inane activities seemingly intended to flush your precious waking hours. As you progress in your service, depending on your specialty, you are likely to assume (or be “voluntold”) a more administrative role. If this conflicts with your wishes, be apprised that the needs of the Army (or Air Force or Navy) far outweigh your own.
As officers, though, we are responsible for those in our charge. If you cannot be a mentor and a leader at the same time that you are balancing your clinical practice, then becoming an officer might not be a great idea for you.
#2 Are You Prepared for the Sacrifice?
To be a member of the Armed Forces of the United States is an honor inextricably tied to sacrifice. You will be held to a stringent standard of behavior, limited in your autonomy to choose where you live, when you work, how you work, and with whom you work. The Constitution that you swore to protect and defend applies to you, but there are limitations. From the justice system (Uniformed Code of Military Justice) to your freedom of expression, joining the armed forces isn’t so different from becoming a citizen of an entirely different culture. You will be obliged to maintain a level of physical fitness suitable for rapid deployment to the war-torn nether-regions of the world for inordinate amounts of time. In harm's way and in defense of your country, you may be maimed or killed.
If you are selected for your specialty of choice (see below), you may find that after your residency is complete, your civilian counterparts are making twice, four times, or even in excess of nine times your salary.
Importantly, you may be single at the time you sign your HPSP contract and married by the time your service starts. You may even have a family. What will your priorities be then? While it is exceptionally difficult to predict how our life goals will change, let it be known that military families serve every bit as much as the service members themselves.
#3 What Is Your Preferred Medical Specialty?
Keep in mind that the military loves a good multi-tool. In this case, a general medical officer (physicians who have completed internship only) is a “satis-excellent” choice for most units' needs. If you are looking to specialize or sub-specialize, competition within the military match system can be fierce, and it's not uncommon for match rates for a given specialty to be much worse in the military than on the civilian side of the house.
For instance, I have participated in this match (formally referred to as the Joint Service Graduate Medical Education Selection Board) four times. I have successfully matched only twice.
I am no Osler, nor am I a slouch. Because the selection process favors physicians who are finishing a general medical officer tour or who are “out in the field”, graduating medical students are generally prioritized last for training. So if you are a fourth-year medical student competing for a rare specialty position against a group of more senior physician-officers, you will probably want a letter of recommendation from Hippocrates to be seriously considered.
With that being said, the somewhat translucent selection process can work well for you if you’ve previously served or are interested in a field that is highly valued within our ranks (think Family Medicine, Emergency Medicine, Anesthesia, Surgery of all shreds). There are certainly benefits to being an active-duty resident, as well, and I have found that military-training programs generally produce excellent, competent, and well-prepared physicians.
#4 What Is Your 20-Year Plan?
Where do you see yourself in 20 years? How will your priorities align with your obligations along the way? If you’ve got a confident answer to this question, I would encourage you to write it down so that you might enjoy a good laugh in a couple of decades.
The military, like medicine, is a fickle lover. You may love it, and you will certainly hate it. Often, there are mixed feelings of both. There are days (or weeks…) when you would gladly separate at the earliest possible convenience and others that inspire you to the point of tears. We are an odd community (and small, representing just 1% of the population), but as the years pass, it starts to feel more like family. For those who reach retirement age (20 years of Active Duty Service), a very generous retirement benefits package awaits. This includes healthcare for life and an inflation-adjusted annuity.
Many military physicians also retire well before 50 years old, leaving decades of high-earning years in the civilian world to continue saving, investing, and giving. Point being: if your family can find a way to thrive and if you can reach contentment and enjoy the experience, then a career in the military can be a fantastic pathway.
#5 What Are the Alternatives?
If you don’t want to incur an Active Duty service commitment, there are plenty of alternatives. For instance, the Guard and Reserves offer a similar scholarship program. The Indian Health Service, National Health Service Corps, and CDC Epidemic Intelligence Service Programs each provide a pathway for loan assistance and/or career progression.
If it seems as if the military option is a stellar fit for you and a possible career-long journey, you might want to consider applying to the Uniformed Service University of the Health Sciences. Alternatively, if you would like to forgo the risk of the Military Match, the Financial Assistance Program (FAP) for residents imitates a grant, offering a stipend and yearly annual salary in return for time served after the completion of training. Finally, as a licensed physician, the door to the military is by no means closed: we are always looking for good people.
Should You Apply for the Health Professions Scholarship Program?
The HPSP isn’t for everyone. There are certainly drawbacks, and I would strongly consider the questions above as a starting point to determine if it’s a good fit for you.
Much of that mentioned above may be construed as negative because much of what we are required to do in the military is difficult, needlessly tedious, and frustratingly purposeless. One should be apprised of this, as much as possible.
But I would like to finish with a few notes on my own experience.
I have been in the military since I finished high school, and a large draw for me was the fact that I had no money, no means to make it, and no direction in my life. Within one month, though, my focus was fixed. I wanted to quit, but I found that I loved the people too much. My heart was with them, and it has been ever since.
In the years since I have met great people who have become lifelong friends. I have been afforded countless opportunities that I otherwise would not have. I met my wife, and we started a family. I have had the privilege of caring for military members and their families, and I've assisted them through loss, deployments, permanent moves, and illness. This has been one of the greatest honors of my life.
My household income is half that of my civilian peers. But our healthcare is covered; we have access to a low-cost, tax-efficient 401(k) system (Thrift Savings Plan); and we are very comfortable.
I don’t worry about job security, even in a pandemic. My children are being raised within a strong community, are exposed to diverse backgrounds and perspectives, and will benefit from the GI bill for college assistance. Life insurance for my wife and me is inexpensive and guaranteed. As a couple, we have engaged with young families starting their military (and life!) journey.
All of this has been richly rewarding. Sure, it took me a little longer to get into the subspecialty of my choice, but the time I had trained in clinic gave me an invaluable perspective on patient care.
It has been a grand adventure, one that will hopefully continue for years to come. There are tough weeks, and there is a lack of autonomy. Uniformity tends to be the rule of the day. Stability is rougher: at any time, I could be ordered to an outpost in North Dakota. But I know who would be going with me, and the type of service-oriented and driven folk that would welcome us when we got there.
The HPSP may not be for everyone, but we welcome wholeheartedly those who would join us.
What do you think? Would the HPSP be the right move for you or somebody you know? If you served in the military as a doctor or are still active, has it been worth it? Comment below!
Let me save readers the time of reading the article:
No. Don’t.
Thank you for a great post!
Great post!
I’ve gone through JSGMESB twice, matched twice, but also been on the resident selection committee side. While the points scale does favor those with prior service time pretty heavily, it’s somewhat service and specialty dependent just how much impact that has. For example, the program I worked with had a fixed number of MS4 vs TY/GMO positions they took (roughly 80% MS4/20% TY/GMO). For our specialty, people “wind up as a GMO for a reason” so there was a much steeper curve to match in later. Other specialties seem to be the opposite and only rarely take new graduates, favoring people with GMO time.
This year’s retention bonus contracts (bonuses for those who have completed their initial obligation) have gone up for many specialties and seem to be closing the salary gap somewhat. A lot of the financial question winds up being a matter of how you choose to do the math. What is Tricare worth to you and your family? Single college kid me signing for HPSP, very little. Mid career me with a wife, four kids, and a dependent mom… Similarly, how do you account for the value of the “scholarship?” Just tack the value of tuition on at the end, vs the complete projected cost of a loan over 10 years that covered everything? Or the value of the pension?
I would argue that you don’t need to be absolutely certain about wanting to be an officer at the outset, but you do need to be at least as certain as you are that you want to do medicine. Can’t know if you’ll like something until you’ve tried it, and there is zero problem with finishing your four years and saying “well that wasn’t for me!” and getting out. You do need to be able to stomach it for that period of residency + 4 years though, so if you’re interested but unsure then maybe FAP or joining post residency is a better choice.
Do not do it for the money though. That’s why I did it (couldn’t conceive of any other way to pay for school) and I wound up enjoying it and will stay for 20. The money isn’t a good enough reason to do it though, the BEST you’ll do relative to civilian depending on specialty is roughly break even.
I attended medical school courtesy of the Navy HPSP from 1973-1977. Friends who knew me before my time in the Navy told me that I was changed by the experience–and not for the better.
Why’d I do it? First, I was incredibly debt averse. Second, I guess you could say that I grew up with a spirit of patriotism and military service. My father was a pilot in the Army Air Corps during WWII. His plane was shot down at Bastogne (Battle of the Bulge). He was, subsequently, captured by the Germans and became a Prisoner of War, imprisoned at Stalag Luft 3 in Poland. My brother served in the Navy during Vietnam. Various aunts and uncles also served in the military.
All that said, I think that I was naive as to the some of the realities of belonging to the military–especially as a female in medicine. One thing that I would advise anybody contemplating the HPSP is that when you swear an oath to become an officer, the military does, effectively, own you. When you swear an oath to protect and defend the Constitution, my experience is that you also give up some (perhaps many) of your rights under that same Constitution.
I was drawn to aviation and ultimately became the #12 female Flight Surgeon in the Navy. I did encounter gender discrimination in the Navy–lots of it. Want to be assigned the middle day of every 3-day weekend? Consider being a female PCP (Primary Care Physician). I won’t belabor the point, but chatting online with a senior Air Force Flight Surgeon, I was told that gender discrimination in military medicine remains a current problem. Consider that as a heads up for any woman looking towards the HPSP as a way to pay for their medical school.
Serving my country in the military remains a source of pride for me–despite the travails. Some of the finest people who I have ever met were in the military. Unfortunately, some of the worst were there, too, and were some of my bosses. It was a mixed bag. On the good side, I got to do things in the Navy that I would never have gotten to do as a civilian doctor–such as fly supersonic in a Navy jet and see the crack of dawn from the cockpit of a VQ-4 C-130 Hercules aloft over the Atlantic Ocean. I got to see a Russian “Bear” pacing us over the Atlantic Ocean.
HPSP? Yes, you will get a “free” medical degree, but there is a cost.
Here’s a link to an article published yesterday (9SEP2021) “Air Force Watchdog Finds Career Disparities for Hispanic, Asian, Female Service Members”: https://www.military.com/daily-news/2021/09/09/air-force-watchdog-finds-career-disparities-hispanic-asian-female-service-members.html?ESRC=eb_210910.nl
Donna,
Thank you for your service and for your perspective. Sharing your experience is instrumental in shaping change.
I have often wondered how I would feel if one of my daughters wanted to serve in the military. I have asked the same of senior enlisted women, as well as senior women officers, and their insight is fascinating. Almost all of those who have served over the last two decades say that they would absolutely encourage their kids (including daughters) in signing up if they desired. Change is still needed, as highlighted by the article that you shared.
It’s not the right choice for everyone (though a public service obligation of some sort for all Americans is an interesting discussion), but the real change we have seen over the last 20 years has been for the better. I would support my daughters if this were to be their desired path, but would be having some very candid discussions about goals-short and long term.
thank you for giving the white coats a fair shake.
My dad is a retired Navy physician. He joined the Navy because he wouldn’t have been able to go to college otherwise.
He and I had conversations when I was looking at medical school, and his advice was that I should only join the military if I wanted to be in the military. He also pointed out that one way or another, the first 4 years after training are paying for medical school, either by being in the military or by living frugally and paying off loans (and this was well before WCI was around!) I made the observation that if I’m not in the military I get to choose where to live for those 4 years, which pretty much sealed the deal for me of not doing it.
I wrote a pretty lengthy reply to the original poster on the forums to this issue. While the merits of military service go without saying, there is certainly an opportunity cost that comes with this. This is certainly more significant for high paying specialties. Also, if you want to train in a specialty that lacks a wartime mission, it will likely be difficult for you to train and practice in the military in the coming years.
https://forum.whitecoatinvestor.com/general-welcome/292091-discuss-latest-wci-blog-post-should-you-apply-for-the-hpsp-to-pay-for-medical-school
To the author, well done on summarizing some of the intangible costs that come from service. Having a service oriented mindset is critical for job satisfaction in the military. Certainly, specialty choice is difficult to achieve. Also, there is a sizeable opportunity cost associated with military service (which is really exacerbated in procedural specialties and current, in vogue high paying specialties). Feel free to review my more detailed thoughts on the forum. I appreciate all of the comments and the author for their insights.
-AMSUMD
Thanks for a good summary! I would point out a couple of things:
1. I agree that the military does a great job training their docs, I feel remarkably well rounded and useful as a military family medicine doctor. However, with DHA taking over and having unknown plans for GME, I would be extremely cautious for anyone who is not planning on a bucket one specialty. You may find yourself spending your service doing a GMO tour and having to get out to to try a civilian match all of which are getting more competitive as medical schools increase class size and residencies do not. Civilian residencies are also not known for prioritizing someone who has been out of medical school for years though they may make an exception for military.
2. The administrative burden of MEDCOM is often out of control and as a military doctor you will be powerless to fix it. Trying to fix the systemic issues can get exhausting and will cause burnout without a lot to show for it. I have found job satisfaction goes up with FORCECOM jobs however maintaining medical skills becomes a challenge. I think four years is a fair payback but if you actually want to be a doctor, I would not plan on 20. Very few high ranking doctors are actually functioning doctors and even less are up to date.
3. Finances: the military will set you up well. I will be the only family medicine doctor I know who is debt free at 34 once I finish my commitment. The freedom with that is really amazing. The army has made me question if I will continue in medicine at all after my time and knowing that I am coming out trained for a profession with no debt gives me a lot of choices. The army also gave me the opportunity to start retirement accounts young and invest a lot early. You don’t really need as much of an emergency fund when you are essentially not fireable. I don’t think there is a problem going into HPSP knowing you aren’t going to serve 20 years. I still do my job well and am committed to it but also have a lot of relief that I only signed on for 4. I know a lot of the USU grads who regret the 7 years they owe.
I would also highly recommend that any prospective medical student talk to a military doctor in addition to the recruiter. My recruiter had no concept of life as a military doctor or many of the unique aspects of it. He also basically told me that it was easy to get medically discharged if I didn’t like the army (not true at all). If anyone has specific questions, I’m happy to answer what I can.
Best of luck to everyone!
Katie,
Your input is much appreciated, as is your service!
The changes in military GME are nearly impossible to accurately predict. As long as I’ve been in (awhile now), there have been mutterings and forecasts for a Medical Service that is more dependent on civilian contracts and local support. Thus, a smaller GME footprint. We’ve only seen moves in this regard over the last 3-4 years. You’re absolutely right, though: prospective HPSP recipients need to be aware of the current environment. More to come on that front.
The DHA, soon to become the nation’s largest healthcare system, seems to me a black hole. And, we mentioned, the greater your rank, the greater your admin burden (generally). Its a double-edged sword: opportunities to pursue things like Chief of Medicine positions, or advanced certifications (MHA, AAPL) are also seemingly easier and cost effective.
Thanks again for your perspective, its spot-on. Take care out there.
-Chuck
Great post and comments, but having retired this year after a great career, I think the hard truth that med students need to consider when applying for HPSP is this: you need to be happy enough being an officer that if the military royally screws you, that you won’t regret your initial 4 year commitment. What do I mean by royally screwing you? It depends on your priorities but usually one of the following:
1. Not being selected for your residency of choice (maybe not even offering slots for you to apply to in a given year, when there were ample residency slots in your residency/fellowship of choice in recent years).
2. Getting sent to a location where your spouse can’t work/ go to school/ be near family to help raise kids,.
3. Deployment fatigue (especially when colleagues are medically unable to deploy, and no, I’m not just talking about female physicians having multiple children).
4. Being told how to practice by leaders who range from excellent to completely inept (and in many cases not physicians) which can lead to seeing your skill set rot.
5. Not being promoted (this never used to be an issue but is increasingly becoming an issue even at lower ranks) and as you spend more time in the military, there is a clear inverse correlation with being an excellent clinician and getting promoted to O-6 (Captain/ Colonel). For those who do attain the rank of O-6, it is almost impossible to practice medicine which can lead to a lifetime of crappy VA/ hospital administrator roles after retirement.
The fact that your colleagues may have the kind of wonderful career that I had makes it even harder for those who get screwed to not be miserable and/or burn-out. What ultimately gets someone through all this is the desire to serve.
Hi Katie,
Thank you so much for your post and your service.
My fiancé and I are on the brink of having to make a decision regarding her attending USU. We desperately are looking for some wisdom on the implications this will have on our family and careers. In total it will be 11 years (she already owes 4 years from ROTC) of service after med school. Do you know of any USU grads that would be willing to chat to us about this? It’s a pretty daunting decision and we have come across very few resources online to better inform our decision.
Many thanks,
Shane