So you want to be a United States military doctor. You want to serve your country, travel around the world, and be at the cutting edge of medical technology. This is what it means to be a military doctor, and we’ll help you decide if it’s a good field for you.
Welcome to our next installment in So You Want to Be. In this series, we highlight a specific specialty or discipline within medicine, such as being a military physician, and help you decide if it’s a good fit for you. You can find more specialties on our So You Want to Be tag.
Military medicine is widely misunderstood by us civilians. We’re going to be comparing military medicine to civilian medicine, so it will make the most sense if you are familiar with the civilian medical training process. If you’re not, then take a look at this post to get a brief overview.
The Two Paths to Military Medicine
To become a physician in the military, there are two main paths to choose from: the Health Professions Scholarship Program, or HPSP for short, and the Uniformed Services University of the Health Sciences, also known as the USUHS.
HPSP is the more common path of the two, whereby you go to any medical school, whether osteopathic or allopathic, and here’s the kicker: your tuition is entirely paid for and you also receive a monthly stipend for living expenses. For the most part, your medical training is pretty similar to that of your civilian counterparts. However, as an HPSP recipient, you will have basic military training, most commonly during your second year of medical school. During your clinical years, meaning third and fourth year, you are usually granted the opportunity to become “active duty” and rotate at military hospitals if you choose.
So what’s the catch? The United States military paid for your medical school education, so it’s only fair to pay it back. Generally speaking, there’s a 1 to 1 payback in service to the military under HPSP. That means if you graduated from medical school after the traditional 4 years, you are required to be a physician serving in the military for at least 4 years after completing your training. While you are of course being paid when you are serving as a physician, note that military compensation rates are usually lower than civilian counterparts.
The main benefit to HPSP is that you have complete flexibility to where you attend medical school. Want to go to UC San Diego and enjoy the awesome weather? No problem. What about staying at Ohio State to be close to family? Also totally fine.
The downside is that unless you’re attending a medical school that has several HPSP recipients, you will be isolated from the rest of the military medical training process. You won’t be exposed to the military match process, the military in general, and you won’t be participating in drills or field exercises.
The USUHS is the military’s medical school. Like HPSP, tuition is completely free, but rather than a small stipend for living expenses, you’ll be serving as an active duty 2nd Lieutenant and paid as such, which is around $40,000 per year base pay, with about another $20,000 of non-taxable income for housing.
The most obvious downside is that you won’t have a choice in where you attend medical school – you’ll have to attend USUHS, which is located in Bethesda, Maryland. Additionally, the payback period is longer than HPSP at 7 years on average.
That being said, there are several benefits to this path. You’ll be fully integrated into the military medical training system from the get-go, and that means many more opportunities, unique experiences, and full immersion into the military culture. Of course, you’ll be participating in field exercises, but it gets much more exciting than that. For example, you can gain early exposure and do rotations in humanitarian medicine, disaster medicine, rotate across the U.S. and even internationally.
How is Military Medical Training Different?
The world of military medicine shares many similarities with civilian medicine, but is in some ways a world of its own.
As a military physician, it’s not only necessary for you to be a specialist in your field, but also a competent and flexible generalist while deployed. For example, a general surgeon, while deployed, may be asked to do cases more typically reserved for a neurosurgeon, otolaryngologist, or urologist. Alternatively, a pediatrician may be deployed as a battalion doctor, the military equivalent of a primary care physician.
This is a difficult and stressful aspect of military medicine, but it’s mitigated by a strong support system and excellent training. You’ll always have someone to call to ask for help or clarification. And these cross-specialty responsibilities are only reserved while you’re deployed. Back home, you’ll stick to working within your intended specialty.
Military Match & Specialty Choice
The military match process is an entirely different animal. The regular civilian match occurs in March, but the military match occurs in December. All specialties are still available for residency training, however, the military is working to curtail the number of “non-deployable specialists.” For example, the military will still train pediatricians but may limit additional subspecialty training in fellowship.
Once you graduate medical school and start residency, you are promoted to captain in the Army and Air Force, or to Lieutenant in the Navy.
A majority of graduates match into their intended specialty of choice. For the Army, that number was 85% in 2018. The Air Force’s most recent published number was 85% for 2017. Taking into account specialty and location, in 2016 72% of USUHS graduates got their first choice of specialty and site (across all branches). The Navy is a bit different in that the majority of their graduates will complete an intern year and do a General Medical Officer Tour prior to completing residency.
A General Medical Officer, or GMO for short, is essentially a primary care plus doctor. After completing intern year, GMOs are assigned to different units. Depending on their unit, they will undergo additional training, lasting months to years, to best be in service of their unit. For example, Navy flight doctors will go to flight school where they will learn not only about the physiology involved in flying fighter jets and helicopters, but they themselves will also learn to fly. They’ll work with pilots, go in jets, and experience multiple aspects of the unit. The goal is to make them experts in their respective fields. GMO units have a wide range, from flight medicine to dive medicine, and much more.
As a GMO, you can expect to get significant field experience and even deploy, with tours usually lasting 2 to 3 years. During this time you will be treated and salaried as an attending physician.
GMO’s are colloquially referred to as “surgeons,” such as flight surgeon, dive surgeon, etc. However, they are not surgeons. If you want to be a surgeon and actually do surgery, the military has training programs for the traditional surgical specialties such as general surgery, otolaryngology, orthopedics, urology, etc.
If you don’t become a GMO, you will proceed with residency training in a similar capacity to civilians. The main difference is that you will be required to fulfill certain military requirements such as physical fitness tests, drills, and online training. Some programs offer the opportunity to attend military schools, such as airborne, air assault, or flight medicine.
Those that fail to match will complete a transitional year, and they will reapply during the subsequent match. If they go unmatched again, they will go on to become a GMO. Navy graduates have the highest rate of graduates becoming GMO’s. This has nothing to do with the applicants — it’s just part of Navy medicine to have GMO’s with units. The lowest rate for GMO’s is in the Army with the Air Force in the middle.
Who Should Consider Military Medicine?
Military medicine is certainly not for everyone. Here’s how you can decide if it’s a good fit for you. First, consider the downsides. If any of these are deal-breakers for you, then it’s likely not a good match.
The average military physician makes approximately $150,000 to $200,000 per year, depending on your rank, although that is not fully accounting for specialty bonuses. As a civilian, you can make much more, depending on your specialty. As a primary care doctor, you’ll be making a similar amount, but as an orthopedic or neurosurgeon, you’ll be making 2-3x that amount.
Inflexible Practice Location
As a military physician, you don’t have much control over where you’ll be living and practicing medicine. While you can certainly submit preferences, it’s ultimately up to the military to determine where you are most needed.
Additionally, after residency you can be deployed at any time, and that usually means significant time away from your family and loved ones. There are, of course, risks if you are deployed to active war zones.
Limited Fellowship Options
If you’d like to subspecialize with fellowship training, understand that while it is certainly possible, the military limits the number of fellowship trainees every year. Between 2016 and 2018, only about 50% of Army doctors who wanted to do a fellowship were allowed to do so. That said, if you are permitted, military physicians typically go to top flight fellowship programs.
Lastly, as they say in the military, you need to “embrace the suck.” If you are in military medicine, you will be deployed, and you will find yourself in conditions that are not comfortable.
Military medicine requires a greater level of flexibility and creativity than civilian medicine. Think of the generalist having to perform specialist surgeries while deployed. Additionally, you will have to work in austere, unique, and changing environments. Military medicine can be practiced in active war zones, areas recovering from conflict, pandemics such as Ebola, humanitarian missions, global training exercises, and areas subject to natural disasters such as hurricanes and tsunamis.
Military medicine allows you to serve your country, see the world, be with America’s finest, get additional training, work with world leaders in the field, push yourself, and do things you never thought would do. It’s not for everybody, but for those who do pursue it, there is nothing quite like it.
If you’re wondering how I know so much about military medicine, it’s because of our awesome team of physicians at Med School Insiders, several of whom are current military physicians. Maybe you need help deciding if military medicine is right for you, or want to ensure you’re as successful as possible given its unique training intricacies. Regardless of your situation, our team at Med School Insiders can help. Feel free to reach out with any questions.
What type of doctor should I cover in the next So You Want to Be post? As always, thank you all so much for keeping up with our blog. Much love to you all.