What it's like to be a military doctor -- and is it the right path for you?

By Bill Jackson March 15, 2024 20 mins read 122 Views

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By Dr. Charles Patterson, WCI Columnist

A career in medicine through the Armed Forces can be an exciting, rewarding, and fulfilling experience. Even a shorter period of service can be a foundational and worthwhile venture. For those well disposed to the opportunities and lifestyle, the idiosyncrasies and challenges are an acceptable tradeoff. But because one can never fully know what it is to live a monumental career decision until they are committed, it is critical to understand the systems, processes, and cultures that define it, especially if you're interested in becoming a military doctor.

What it's like to be a military doctor -- and is it the right path for you?

There are countless websites, blog posts, recruiters, and individuals eager to share this opinion or that experience. Finding a well-balanced set of perspectives is paramount in navigating the decisions that make or break a service commitment. Here at The White Coat Investor, you will find a trove of resources, from career considerations to a community of active, separated, and retired military physicians.

Sifting through the noise to find the answers that support career progression is a tedious process. In the following paragraphs and through associated references, we will provide a framework for building your answers. Generalities and common wisdom will be introduced, with credence to individual circumstances. No single strategy fits all, as our responsive, diverse, and growing body of military white coat investors can attest. Our goal is to promote financial literacy, bolster wellness, and highlight critical resources in your military journey.

Determining Whether a Career in Military Medicine Is Right for You

The Armed Forces are composed of a diverse population of servicemembers, all focused on the mission at hand. With respect to advances in broader representation of the American people, most who go through basic training will notice that those around them come from every state, all walks of life, and from every creed and philosophical background. Everyone has a story, just as each has their own reasons for entering. Identifying and internalizing your motivations is critical. But whatever your reasons for considering military service as a medical professional, it would behoove you to carefully consider the following questions:

1. Do you want to be a military officer? Physicians, nurses, and mid-level providers all serve as officers. Understanding the basics of officership is crucial in determining whether this pathway is a good fit.
2. What are your 10-year career goals? Especially if entering service through medical school, a commitment to the military may mean years of operational service and/or training prior to board certification. While the commitments themselves may be as little as 2-3 years, knowing where you want your career to be in 10 years is invaluable.
3. What does your best life look like in 20 years? Let's face it: while the decision to join up shouldn’t be all about money, physicians in the military can make substantially less than their civilian counterparts. Understanding what post-service life could look like will help in filling in your decision matrix. There are many worse things in the world than a military pension.
4. What are your family and personal goals? It's easy to join when you are 18 and tomorrow is the only day that ever will be. But having the foresight to research and imagine military family life (the good and the bad) will cage expectations, anticipate future frustrations., and plan for resource utilization.
5. What are your ideal work conditions? Military service affords some unique practice opportunities, from aerospace medicine to humanitarian and global health initiatives. While not always predictable or mandatory, these can be exciting—equal parts strenuous and career-defining. Are you well disposed to them?
6. How will this affect my financial life? The decision to take the “military scholarship” is not as simple as signing up for the Health Professions Scholarship Program (HPSP). Be forewarned, there is no free lunch, and there is no free medical school. Having a written financial plan that incorporates savings goals and a timeline for financial independence is paramount. The Medical Corps, while not for everyone, can be constructive for your financial plans and life balance.

This is by no means an exhaustive list of critical questions, but it's an important start. Regardless of your decision to join, thorough consideration of the above will help you to know yourself and the Armed Forces just a little bit better.

How to Become a Military Physician

There are many roads to Dublin and several into the Medical Corps. The majority of physicians enter through the HPSP, which is more appropriately termed a contract rather than a scholarship. In exchange for financial benefits during medical school (tuition, required fees, equipment, and a living stipend), the enrollee (and future officer) incurs an obligation for military service referred to as an Active Duty Service Commitment or ADSC. Prior to the HPSP, a fair amount of military physicians began their careers in ROTC or through a service academy, which incurs an additional service commitment. Independent of the HPSP program, the Department of Defense (DoD) operates its own medical school, the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland. USU is generally recognized as an excellent teaching institution that prepares its students well for a career in medicine.

While these platforms are by no means the only way to start a military career, they serve as good introductions to the culture for students who are enthusiastic about officership.

The pathway that one takes to become a military physician dictates the length of the service obligation. For instance, a student who begins at age 18 at a service academy (five-year commitment), then enters USU (seven-year commitment), and then goes through orthopedic training and a spine fellowship may not begin to repay their 12-year obligation until they are 32. Conversely, should a student receive all of the same education and training through civilian institutions and traditional student loans, programs such as the Health Professions Loan Repayment Program (Reserves) and Financial Assistance Program can offset loan burden as a benefit to signing on without the extensive service obligation. Limitations and eligibility requirements apply to each program, and compensation and benefits packages are also dependent on the avenues taken.

Notable alternatives to the HPSP include the HSCP, the National Health Service Corps, and the Indian Health Service. Further loan repayment and assistance are available through the Financial Assistance Program, which may afford more flexibility in your specialty choice. Guard and Reserve positions are also possible and bring with them nuance and flexibility that differentiates them from active duty.

Should I Join the Military to Pay for Medical School?

As a general rule, money alone is not a compelling reason to join the military as a physician. Despite the HPSP “scholarship,” possible bumps in pay for active duty training platforms, incentive pays, and bonuses, many (if not most) civilian pathways are still more lucrative in the long run. But if we're talking about general rules, we should also note the exceptions. If you are a dumb doctor and are prone to dumb doctor tricks, neither private practice nor the Medical Corps is likely to save your investment accounts from yourself. If, on the other hand, you are entering a highly compensated medical specialty and are both financially literate and diligent, the time spent in service may set your lifetime earnings back magnificently.

How you calculate cost and value matters. For primary care physicians, officer compensation may not be that far off from civilian peers. Medical benefits packages, tax efficiency, education programs, and retirement benefits bring total lifetime earnings (and security) to near parity. Frankly, however, so much depends on one’s financial behavior that comparisons devolve as quickly as exceptions present. One does not join the military to get rich. One can become wealthy via this route, but that endpoint is predicated on habit, not mechanism.

The short answer to the question is that one should become a military physician if there is a desire to serve as an officer and if one would reasonably find fulfillment in working in the Medical Corps. With prudent savings and investment, you will come out of that service in a fine position. But joining for the money alone is unwise. Those who pursue a life in medicine for the money are likely those looking for a pathway into industry or to practice entrepreneurship, or they have an ownership stake of some kind.

For the rest of us, the decision to enter medicine was made on the promise of helping fellow humans and with the goal of doing well by doing good for others. Income is important, and the pay discrepancy is a deal breaker for many considering service. But fulfillment in your career—like contentment in a relationship—is predicated on more than finances.

What Are the Benefits of Being a Doctor in the Military?

Service benefits are both objective and intangible. For those looking to avoid monetary debt, service under the military umbrella affords one the option of receiving an income through training and coming out the other end without a mountain of student loans. While the paycheck isn’t massive, it can provide a household with a positive net worth early in the career. Access to employer-matched retirement accounts, a pension, affordable healthcare, and increases in pay in high cost of living areas and inflation can buffer the challenges of balancing quality of life and savings. Programs such as the GI Bill, Yellow Ribbon Program, and VA loan program help offset some of life’s largest expenses. Additionally, access to military facilities like gyms and grocery stores and receiving services such as car repair, veterinarians, and recreation centers provide a cost-effective means of maintaining a comfortable and enjoyable life.

There exists in the Armed Services opportunities otherwise unavailable to most civilians. Thus far, I have undergone survival training, participated in freefall jump (parachute), rappelled out of helicopters, cared for refugees abroad, traveled extensively, coordinated mass casualty response teams, led multiple clinics, and had a seat at the table for medical planning at an organizational level. These are just the start. It has been fun: good, tiring fun.

Military physicians practice in a unique setting. Naturally, deploying to areas in conflict or in the throes of a humanitarian crisis will present the physician with pathology rarely seen in the US. For the majority of the time, the practice setting will be stateside in a medical treatment facility. Resources can be spartan, but dealing with insurance is less of a headache (that's been my experience, but I appreciate those with different opinions on this point). Administrations—like at all civilian hospitals—can be burdensome or incredibly valuable depending on the command. But the folks with whom you work are generally motivated, competent, and diverse. Large organizations like the Defense Health Agency can be cumbersome and confusing, but the people who work with you day to day tend to be helpful and engaging. Some of my closest friends and mentors were made in military health facilities, and if I am not grateful for the system, I am certainly grateful for them.

To me, the benefits of being a doctor in the military supersede the paycheck. The medical profession is enriched by a spirit of altruism (and soured by a litigious, algorithmic, and dehumanizing culture). The intangible benefits of military medicine are an extension of that principle. Part of one’s compensation for military service is inherent to the service itself. It's a messy business: tedious and sometimes mind-numbing. Not everyone will be enriched by a military commitment, but those well suited to it can take distinctive pride in the ability to help warfighters and their families.

How Much Do Military Doctors Get Paid?

As an officer in the Armed Forces, military physicians are entitled to compensation commensurate with their specialty, certification, seniority, and duty station. The pay structure is publicly available, and it starts with basic officer pay, which increases with rank and time in service. Allowances for food, housing, and cost of living adjustments (COLA) for high-cost-of-living areas are also applied. A broad suite of bonuses is also offered for board certification, specialty incentivization, and retention. In combination, these bonuses can double (or more) the basic pay package.

military doctor

Eligibility for these, of course, depends on certification and service commitment status. Depending on specialty and route of entry, loan repayment, critical wartime accession bonuses, and BRS Continuation Pay may apply. Tax breaks (in the form of non-taxable housing allowances) can be substantial. Moonlighting opportunities typically depend on command approval, but they are a fairly common practice.

Stated plainly (but with emphasis), military physicians earn less than their civilian peers. In some cases, this pay discrepancy can be more than six or seven digits. A pre-pandemic Government Accountability Office (GAO) report highlighted the disparity in intra-specialty pay, and while recommendations were made with regard to changes in the incentive and pay structure, few have been adopted. Whether this will change anytime soon is anybody’s guess, but most are betting against it. The reason is simple: physicians are among the highest-paid members of the DoD, and unless there is a recruitment or retention deficit, the political will to add to their paychecks is nonexistent.

What Are the Specialty Choices Available in the Military?

The Department of Defense needs most medical specialties. However, it may not need many of a given type, and, thus, the opportunity to train in one’s preferred field may be limited. The blueprint for vectoring into a given specialty in the military should be known and well understood prior to committing to the HPSP or another recruitment program. Every year, on the advice of consultant physicians, the Surgeon General publishes a list of residency and fellowship training positions for which eligible students and officers may compete. Training may be at military-specific sites, integrated military/civilian programs, or at solely civilian institutions. Mindful that funding and sponsorship type directly impact service commitment, applicants vie for the platform of their choice in a cycle that roughly mirrors the ERAS process.

The Military Match can be complicated. For students without military experience applying for the first time, it can be an intimidating and disorienting venture. The good news is that there are well-vetted resources that can be of tremendous help in navigating it. Knowing your desired specialty, embracing it as an officer, and setting reasonable expectations are foundational in a successful match experience. There is much, much more to be said on the topic of the Military Match. Familiarity with its idiosyncrasies is a good starting point.

For those who do not match into their desired specialty, options for PGY-1 only (typically Internal Medicine, Surgery, or Transitional) are executed. Thereafter, most will either re-enter the Military Match process or serve their commitment as a General Medical Officer (GMO) or Flight Surgeon and separate to complete residency as a civilian.

Finally, a physician may enter service having already completed their training and certification. This pathway foregoes the need to participate in the Joint Services Graduate Medical Education (JSGME) process, and it can apply to Active Duty, Guard, or Reserve positions. While there is no guarantee of availability, it serves as a route of entry for those looking for more flexibility before a commitment.

What Insurance Do I Need as a Military Officer?

As much as any other physician, military docs need to insure against catastrophe. All servicemembers are eligible for Servicemembers' Group Life Insurance, or SGLI, which provides up to $500,000 in death benefits at the cost of $30 per month. This is a fine start but is unlikely to come close to the amount of term life insurance advisable for folks with dependents. Additional term life insurance is widely available commercially and is typically unencumbered by military affiliation. Insurers abound for all other types of insurance (home, auto, renter, umbrella, etc.), and there are several reputable WCI affiliates that I have personally used and have provided great service.

Unique coverage considerations for military physicians include malpractice and disability. Military physicians practice as agents of the United States government, and malpractice claims brought against them are adjudicated under the Federal Tort Claims Act (FTCA). The interpretation of the law, known as the Feres Doctrine, has meant that indemnification of military physicians practicing medicine on behalf of the Service is very difficult for plaintiffs. This policy has been the subject of inquiry and challenge for the last 70 years. In spite of several recent reforms, doctors don’t typically carry malpractice insurance for their military practice. Importantly, the FTCA does not apply to moonlighting or non-service-related employment. Thus, malpractice insurance may be a necessary consideration for off-duty medical practice.

Special risks apply to military physicians participating in fun such as combat operations, flight status, ordnance disposal, diving, and parachuting. While basic income is intact when injured and on active service, long-term disability is expensive and difficult to secure. It stands to reason: insurers know that there are corporeal risks associated with what military physicians do. As a result, you will pay more, and a myriad of exclusions will apply. The VA’s Traumatic Injury Protection (TSGLI) will provide short-term coverage in the event of an injury but will not replace the potential income of an encore civilian career in the event you are maimed while in uniform.

In asking dozens of peers in the Medical Corps over the years, I have found that exactly zero have sought supplemental disability insurance. Most didn’t see the need for the expense (especially on an officer’s salary), and most were not in heavy operational billets. Whether this represents prudence or hubris, I am unsure. However, at the very least, the individual should be aware that their risk of injury is higher while serving in the military.

[Founder's Note from Dr. Jim Dahle: I had a disability policy when I entered, and I maintained it throughout my service. It would have paid had I been injured or gotten sick, except as an act of war.]

While retirement benefits include healthcare coverage for those who have reached eligibility, Long Term Disability Insurance (LTC) is not guaranteed. At the time of this writing,no federal option is available and, as such, is a moot point. However, for those who determine that insuring against financial devastation at the end of life is in the best interests of their dependents, LTC may be worth pursuing. This is a family-specific decision, and provisions to ensure it at a reduced rate at a governmental level are not promising.

Should I Buy a House While in the Military?

For most active duty members, buying a house is not advisable. For the associated transaction and operating costs to be worthwhile, physicians are best served by acquiring a mortgage on a home that they are likely to stay in for as long as possible—typically a minimum of 4-5 years. Even if your housing needs and wants don’t change in those years, the ideal appreciation is not guaranteed. Because most duty assignments are 3-5 years in duration and they can end unpredictably, anchoring your financial life to a large fixed expense in a transient location should only be done with eyes wide open. Cautionary tales of home ownership on active duty abound, and the hard-learned lessons of others should be considered with gravity.

That being said, there are exceptions to this rule. Many military physicians, myself included, have done very well buying and selling homes throughout their careers. Whether this is due to thorough planning, dumb luck, or a mix of both is arguable. To maximize the odds of success, though, there needs to be some contingency plan to either keep a home as a rental following reassignment in the event of an interval market downturn or return to it after separation. If you have no plans of returning to a duty location, you don’t want to be a long-distance landlord, or you can’t afford to sell the home at a significant loss, home ownership in the military is probably not for you.

What Retirement and Investment Accounts Are Available in the Military?

There are several retirement and investment accounts specific to members of the DoD. First and foremost, military members have access to the government-structured 401(k) called the Thrift Savings Plan or TSP. This account follows most of the same rules as a 401(k) from a civilian provider with the most obvious differentiating factor being the investment choices. Funds available within the TSP mirror the large cap, small cap, international, lifecycle, and fixed income funds of the large investment houses, and they are both low-cost and tax-efficient. The G Fund is a fund unique to the TSP, and it provides Treasury bond yields with money market risk.

Servicemembers have a Roth option, and newer features include the ability to invest in outside funds. The Service matches TSP contributions up to 5% for those enrolled in the Blended Retirement System (BRS). This is in addition to the retirement annuity, giving those with career aspirations added confidence in an aggressive portfolio. IRAs—and (for those inclined to pursue 1099 income) SEP-IRA or solo 401(k) accounts—can be arranged independent of work in the Armed Forces.

Savings specific to the military are paired with deployment and are intended to help relieve financial burdens at home. For those deploying, the Savings Deposit Program and increases in TSP contributions paint a silver lining on an otherwise inconvenient work trip. Wills can be set up free of charge on base and updated periodically for the same price. If one’s assets need further protection or they demand specific attention, trusts can also be established. While servicemembers do not have access to Health Savings Accounts, they can participate in the Dependent Care FSA, which is designed to provide some amelioration from the costs of child care and the care of physically impaired or developmentally delayed dependents.

When Should I Leave the Military?

The decision to leave the military can be as difficult as the decision to join. Both require soul-searching and robust planning. How a government-backed annuity and lifetime medical care factor into your strategy for attaining financial independence must be balanced with the tolerability of the work and personal goals. Playing with a simple Excel spreadsheet will illuminate the break-even point (the amount of time in service at which staying for retirement eligibility is the more financially sound choice).

For a 20-year career, the retirement approximation tool (called the BRS calculator) estimates the value of the government annuity and benefits between $2.5 million and $3 million (depending on time in service, asset allocation, and performance, the total value may be even greater). Some military physicians may be eligible for the pension by their mid-40s, leaving them with an inflation-adjusted annuity, lifetime healthcare, and ample time for an encore career. If you are a retina specialist and capable of pulling in seven figures per year, separating with 16 years of service may still be the right move from a financial standpoint. But for those in primary care and non-procedural specialties, the break-even point is far sooner. As a rule, the less lucrative one’s specialty, the less time in service is necessary for making “staying” financially palatable.

For generalists and those with less civilian income potential, it may only take 4-6 years of active service to reach the break-even point. But 20 years of service is a long time, particularly for those ill-suited to military life. The measuring stick becomes far less objective when considering the stresses on kids and families, the burden of administrivia, subjection to military culture, and the vulnerability to geopolitics.

Several of my mentors have shared this piece of advice with me, and I think it's sage wisdom: when the military is no longer fun, it's time to leave. There are innumerable circumstances and policies in the DoD that are less than fun, but if you are starting to experience burnout, it's a good sign that the military is no longer your ideal employer. Money is an important contributing factor to the decision to enter, stay, or leave, but it is only one of many equally important considerations. If on your quest to retirement eligibility (or financial independence), you burn bridges with your spouse, your kids, and your friends while losing sight of the goodness of your work, I dare say it probably was not worth it.

The Bottom Line

The purpose of this article is to introduce and briefly comment on the most prescient questions facing prospective and current military physicians. White coat investors represent a diverse readership, many of whom carry a wealth of experience in military medicine. They will be quick to point out the gaping holes, nuances, and exceptions to the answers delivered above. But while each question is worthy of an expansive response, it's beyond the scope of this introduction. Fortunately, the robust library of articles posted on this site—in conjunction with reader responses, the WCI Forum, and the WCI podcast—provide up-to-date policies, interpretations, and opinions. Navigating the ins, outs, and in-betweens of military life can be difficult without a roadmap. The resources here at The White Coat Investor are in place as a living guide.

The decision to serve as a military officer and physician is personal. The truth is that it's a difficult life that is less lucrative than the civilian sector. Financial implications notwithstanding, decisions to enter, stay, or separate are challenging, and miscalculations can have profound implications on your quality of life. But this life of service need not be destructive to your long-term personal and professional goals. Whether it's discerning a career, bolstering financial literacy, or considering options for separation or retirement, The White Coat Investor community is here to help military physicians plan for financial security, maximize resources, and thrive through adversity.

The views expressed in this article are those of the author and do not reflect any official position of the Department of Defense or the US government. These writings are not authorized, approved, or endorsed by any of the above entities.

What other questions do you have about life in the military as a doctor? Were you a military physician? What was your experience like? Comment below!

The post What It’s Like to Be a Military Doctor — and Is It the Right Path for You? appeared first on The White Coat Investor - Investing & Personal Finance for Doctors.

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By: Josh Katzowitz
Title: What It’s Like to Be a Military Doctor — and Is It the Right Path for You?
Sourced From: www.whitecoatinvestor.com/military-doctor/
Published Date: Fri, 15 Mar 2024 06:30:09 +0000