By Dr. Charles Patterson, 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!