[Editor's Note: This guest post is from Christopher Davin Sanders, MD, Capt USAF,
a PGY3 in radiology at David Grant Medical Center and an Air Force officer. Together with his wife, he blogs at the Finances and Fatigues Blog. He originally submitted this post as an essay for the scholarship. I thought the post was really good, but of course had to inform him that residents weren't eligible to win the scholarship. He did agree to let me use it as a guest post though! We have no financial relationship.]
The Uniformed Services University of Health Sciences is the military medical school located in Bethesda, Maryland. As a USUHS student your tuition is waived, but in return you owe Uncle Sam seven years of service. Is USUHS the right fit for you?
Crunching the numbers
As a USUHS student, you are commissioned as an active duty O-1 with all that entails. As such, you earn an income between $50-60k annually broken down into taxable base pay, and non-taxable Basic Allowance for Housing (which differs based on geographic location and marital status) and Basic Allowance for Sustenance; specifics can be found online under military pay charts. Furthermore,
According to the AAMC, the average civilian medical student graduates with about $180k in debt. [The number is slightly higher now, about $200K, with higher amounts for DOs. That number generally climbs significantly during residency.-ed]
This looks like an automatic win for USUHS, but it’s not quite that simple. To understand we must look to residency and beyond, keeping in mind the maximum earning potential during one’s early years as a staff physician.
Upon graduation to the role of resident on the military side, you are promoted to O-3 and given an annual base income of $47k. Add that to the housing and grocery allowances plus a small bonus for being a resident doctor, then the military resident usually ends up earning $70-80k/year. A civilian resident can expect to earn between $50-60k/year on average, according to the AAMC. Other benefits for the military tract include free medical, dental and vision for the officer and his/her spouse and children. Again, the USUHS graduate is coming out ahead financially at this point.
Post-residency, a military doctor will continue to receive base pay, BAH and BAS according to rank and time in grade. At this point he/she would be at O-3 with 4 years (average) making about $63k/year from base pay alone, which quickly changes to $71k when promoted to O-4 at the 6 year mark. This looks like a pittance for a physician, but this doesn’t account for specialty pays which add up to $35-70k/year. An added bonus for military doctors is not having to pay for malpractice insurance. In total, the average military doctor is most likely earning the equivalent of between $130-180k/year as an attending physician, before signing retention bonuses.
Depending on specialty, civilians begin to pull ahead post-residency. The AAMC publishes starting annual salaries for civilian physicians, ranging from $130k for primary care to $520k for neurosurgeons. So while a family practice doctor (averaging $160k) would probably earn more in the military after factoring in malpractice insurance, board certification, and loan repayment, many specialties would make more in the civilian sector. Therefore, as a civilian subspecialist you could make $100-300k more per year than military physicians and the average $180k of debt could be paid off quickly, catapulting many civilian doctors far beyond the USUHS graduate financially.
I attended USUHS from 2009-2013. Some important factors were:
- I got to travel. As a military medical student I did rotations all around the country, including 3 months in Oahu.
- I was single. This meant that traveling across the country didn’t cause family hardships; many of my classmates brought their families with them on rotations however.
- I come from a military family. My father was a marine and I grew up around other military veterans, so the idea of joining the military was a familiar concept.
- I felt a sense of camaraderie. There was a sense of brotherhood and family between my classmates as we helped each other through the rigors of medical school, rather than the “gunning” mentality at many civilian institutions.
Other factors to consider
Attending USUHS is not just a financial decision but also a personal one. Attending USUHS means joining the armed forces.
- You will be an active duty officer and you will deploy and PCS. You will not deploy as a medical student or resident, but you will deploy as a staff physician. You will also have to PCS, meaning you will have to move where the military needs you, and by extension your family. Be prepared to fulfill the roles of an officer, from being in charge of a squadron all the way down to being able to pass a physical fitness test.
- The four years of medical school do NOT count toward your time in grade. This is one of the most frustrating factors. Even though I was a commissioned officer all four years of medical school, I started my intern year on the pay scale as an O-3 with zero years of military service, instead of starting my fifth year of service. Those four years also don’t count toward earning retirement. However, if I eventually reach retirement at 20 years, I will receive those 4 years retroactively, meaning I will retire with 24 years applied to my pension.
- Being in the military is like being part of the country’s biggest fraternity. People are generally very appreciative of my service and tend to be friendlier; especially other veterans.
- There are many other financial benefits to being in the military. Other great benefits include access to VA loans that require minimal down payments, tax breaks, access to commissaries and base exchanges for cheaper home goods, discounts of 10% or more at countless retailers, access to USAA, and the G.I. bill which will pay for college and even graduate school tuition and can be passed to child or spouse. Additionally, the military has its own version of a 401k, called the TSP, to which you can contribute up to $18k/year into index funds with low expense ratios (0.029%), offered in traditional or Roth options. [Bear in mind that the VA loan isn't a great benefit, especially for a physician eligible for a doctor mortgage loan-ed.]
Is USUHS a good financial decision?
The frustrating answer: It depends on many of the above factors. It’s hard to know what you’ll want to specialize in before you even attend medical school, but if you intend to go into a higher paying field, you will probably earn more as a civilian. If you intend to go into one of the lower paying specialties, USUHS and therefore the military, may be a good financial option. The military life however, is not for everyone and should not be entered based on finances alone. But if you are interested in “Learning to care for those in harm’s way,” then USUHS may very well be for you!
[Editor's Note: Of course, the main factor determining whether or not to go to USUHS is whether or not you want to be in the military. If you do want to be a military physician, then USUHS or the HPSP program are great options. If you do not want to be a military physician, both are a terrible choice. But in general, physicians who joined the military mostly for the money and without realistic expectations of what their experience would be like are not very happy during their years of service.]
What do you think? Did you consider applying to and attending USUHS? What did you like/dislike about it? Were you okay with rotating all over the country? How about going through the military match? What should someone know prior to applying to USUHS? Comment below!