My gift to you is that I’m taking a vacation, so all those wasted hours refreshing to see if I’ve posted yet can be used to a more productive purpose, but only for a week. I’ll be back early next…

http://www.usmedicine.com/column.cfm?columnID=147&issueID=56

The view from the top, no free lunch here either.

Graham:
Good: they have standards and tell you what they are up front. You are not required to agree, you are required to conform.

The program is a good way to avoid big school debts, and that is really important, especially now.

You might like the service and want to stay for the length of a usual full career, but most scholarship recipients do not do this.

If you are interested in a desirable and highly competitive residency and are yourself a good candidate, you may still have to wait several years to get an available slot. Or not.
Opportunity can disappear with one budget cycle in the military; they can and have closed whole, thriving residency programs in one year when projected manning in a particular specialty dictated that they did not need the number of specialists they were training. Remember this if you want dermatology, orthopedics or ophthalmology.

Don’t count on outservice funded training for residency or fellowship. It exists, but oportunities can appear and disappear almost at random. You have to be persistent and lucky.

The U.S. Air Force is the best service to go through if you want a deferment to do a civilian residency. There is no guarantee you will get this, though, and if there is a need for a GMO, they have your number. Remember also that you are on orders when you go to outservice training, and those orders can be changed. You might not get to finish what you started the way you planned. On the other hand, you are far more likely to be assigned to a GMO billet out of the Navy or Army program, especially if you ultimately want a surgical residency spot.

Most recruiters really don’t have a clue about the finer points of the HPSP program, or the follow-on experience. They are out to get competitive applicants and to fill their quotas. They won’t necessarily lie to you, but you won’t necessarily get the whole story, either.

The big downside, in my opinion, is that the services often treat graduate medical education less as a necessary requirement to the complete formation of a trained physician and more as a reward that can be withheld in order to compel doctors to do work that should in this point in time be done by physicians who have completed their residency training. The reason the services do this is because they can and because they do not face the level of medicolegal scruitiny that civilian clinics and hospitals do, where complete training to at least the level of board eligibility if not board certification now almost universally the standard.
It is a shame things still work this way, and anyone going into the HPSP programs really ought to know about this. I know the Navy always liked to wave their JCAHO accreditations around (another rant) and would say, truthfully albeit disingenuously, that all its doctors were fully licensed, counting on the ignorance of their public to not understand that this didn’t necessarily mean that all their doctors were fully trained or board certified.

I don’t regret my decision to go the military route; many of my classmates from medical school are writing big checks every month to repay school loans and I am not. But the scholarship does come with a debt of service to be repaid, on the government’s terms, and that is not necessarily pain-free.