Armed Forces Health Professions Scholarship Program—United States Air Force

An unofficial guide, or

The Most Comprehensive Guide to the USAF HPSP on the Internet

Created September 1999

*Revised and Updated February 2005*

My name is Luke Ballard. I graduated with a Bachelor of Science in General Biology from Cornell University (A&LS) in May 1999. In November of my senior year I was accepted to the University of Rochester School of Medicine, Class of 2003. In April of my senior year at Cornell, I accepted a commission to the United States Air Force as a Second Lieutenant as part of the Armed Forces Health Professions Scholarship Program (HPSP). This last item is what I’m going to talk about here. I’m not a recruiter, I don’t get paid if you join the Air Force, and no one told me to write this. The only reason I’m doing this is because I want people considering applying for or accepting a health professions scholarship to have something more to base the decision on than what a recruiter or a government-issued pamphlet have to say. Namely, I want them to hear it from someone who has been there and done that and doesn't have a huge conflict of interest. The information I offer here is what I have learned from other HPSP students, Air Force Physicians, official Air Force sources, and several years of personal experience. Read what you will . . . from there the decision is up to you.

Disclaimer: Like it says at the top, this is all unofficial. It’s from my perspective so any opinions that may have found their way into these pages are my own and not necessarily shared or endorsed by the Air Force or any branch of the Armed Forces. You should remember that this information may be outdated limiting its usefulness. You should not consider anything written here as absolute fact. You must check everything on your own and get everything in writing from official sources—think of this as nothing more than a guide to help you find some or all the facts you need. Remember: never hesitate to ask questions, continue asking questions until you get a satisfactory answer, and if you don’t get a good answer do your own research and/or find another resource.

AFHPSP: Defined.

AFHPSP stands for Armed Forces Health Professions Scholarship Program. It is offered through the Air Force, Army, and Navy. As far as HPSP is concerned, each branch is slightly different, but the basic idea is the same. This is a four-year scholarship in which the Armed Forces will pay for your medical school tuition and expenses (required medical supplies and required books; currently excludes computers). In addition, they give you a monthly stipend for ten and a half months of living expenses (now over $1,000/month). In return, your commitment is four active duty tours of 45 days each year of medical school (the other month and a half of pay not included in the stipend), four years on active duty as an armed forces doctor, and four years of inactive reserve duty. Additionally, with the Air Force, you are required to apply for an Air Force residency program (which doesn’t necessarily mean you’ll be doing an AF residency).

For those interested in looking at the AFHPSP contractual obligations, click the link. This COPY of the contract is just to show you what the language is like and to provide a broad overview of the program. While the contract you sign will most likely be very similar to the one provided here, YOU MUST READ YOUR OWN CONTRACT BEFORE SIGNING! It could have dramatic differences and will contain details regarding your service obligation. You might be able to find an updated and/or official version of this contract at the HPSP Home Page. This website is significantly more useful to medical students who have already accepted the scholarship than to applicants simply looking for information (another reason for building this web page), but you may find something helpful if you look around.

The Rationale Behind AFHPSP.

The military needs doctors, but there are a number of undeniable reasons doctors would rather work in a civilian capacity, including pay, risks associated with warfare, and lack of freedom associated with assignments to bases, etc. To overcome these drawbacks the government is willing to pay for the professional education of qualified individuals in return for their professional services. In other words, they will pay your way through medical school if you are willing to work for them for as many years later on.

The Basic Terms of the Commitment.

Again, in the simplest terms, the four-year Air Force HPSP scholarship commitment includes:

                                (1) Four 45-day Active Duty Tours (ADTs) during medical school, including Commissioned Officer’s Training.
                                (2) Completion of the USAF HPSP Graduate Medical Education Application (the residency application).
                                (3) Four years of active duty as an armed forces doctor at a military hospital.
                                (4) Four years of inactive reserve duty.

The three-year scholarship requires three ADTs and three years of active and reserve service.

Commissioned Officer’s Training.

The first of four active duty tours (ADT) is Commissioned Officer’s Training (COT), which lasts exactly 30 days. I know I said the ADT was 45 days, but that’s on paper. The final 15 days you spend at home doing whatever you want. During these 15 days you’re allowed limited travel, but aren’t allowed to go overseas or outside the continental US--you’re still technically on military time and they need to keep track of you, so you need permission to do this kind of traveling. This timeframe is standard for any of the four ADTs, not just COT.

For my COT, I spent 30 days at Maxwell Air Force Base in Montgomery, Alabama the summer immediately after graduation from Cornell. There were about four different sessions to choose from, but you may not have much choice; my class was from the end of June through the end of July. COT is not boot camp or basic officer training like pilots go through. Anyone who has made it into medical school should not find it particularly challenging. The training is mostly academic, dealing with three major areas. These include Leadership Studies (how to be an effective leader, manager, problem solver, etc.), Professional Knowledge (including Air Force etiquette, what it means to be an officer, rules, responsibilities, etc.), and Defense Studies (the inner workings and organization of the Air Force). Knowledge in these areas was tested with a multiple-choice exam consisting of 20 questions in each section with a minimum requirement of 80% in each and 80% overall to pass. The average for the entire class was over 90%. There was also a short 20 question multiple-choice exam on the COT Operating Instructions, which cover basic rules and regulations of officer training.

There is also a Physical Training component to COT. Our PT focused on a 1.5 mile-run, pushups, and sit-ups. PT was every other day, and every other PT session focused on either aerobic or anaerobic exercises. All in all it wasn’t very difficult and they didn’t focus on meeting any minimum requirements. An upper tier—which qualifies for an athletics award—included 88 pushups, 88 sit-ups, and a 1.5-mile run in 7:15. However, people did as few as 5 pushups and sit-ups and took well over 15 minutes in the 1.5 mile-run without any impact on their standing with the AF or with respect to their scholarship. Anyone who is moderately athletic shouldn’t have any trouble (though hitting the gym a few weeks ahead of time doesn't hurt). In previous years, the PT was based on a point system in which participants could play sports, run, or workout on their own to fulfill the PT requirements, but they changed that before my session. I’m not sure what the future holds for PT, but plenty of people were displeased with the way things went my year.

For updated information on COT please refer to the USAF Officer Training School (OTS) Homepage (click on their Commissioned Officer Training Program link). Again, I HIGHLY RECOMMEND READING THIS. If anything, please understand this: To be a military officer you must be able to complete the training as described (i.e. you must meet the physical and mental demands of military training). Do not accept the scholarship assuming that this is going to be easy, just because it was "easy" for some in the past! I say this because of the evolving nature of COT--past sessions are not necessarily a reflection of the current conditions at COT. For example, future COT sessions may have a difficult over-night field-training component or other additions that I did not experience. Moreover, COT during the summer of 2000 was highly demanding, though I have been informed that, based on feedback from attendees and the Surgeon General, the requirements have been relaxed relative to this session and are now more appropriate. I anticipate future COT sessions to be similar to my experience described here with some changes to be expected.

Active Duty Tours--Beyond COT.

After COT there are three more active duty tours to complete. The next ADT will most likely be the summer after your first year and will be 30 days long again, though you will be "active" for 45 days. This is when you start to get involved with AF medicine. Options for the first year include, but are not limited to the School of Aerospace Medicine (SAM) program, which is popular and has been described to me as a continuation of COT with more exposure to AF medicine. As for myself, I participated in the Introduction to Clinical Surgery program, which allowed me to interact with AF surgeons of various specialties, shadow them during clinic, and scrub-in during surgical procedures. It was a great experience that helped me gain a better understanding of what it is like being an AF doctor and also helped prepare me for my clinical rotations later on during my third year of medical school. I also had the chance to meet other HPSP students on the rotation and had a great time getting to know each of them a little better.

The following two ADTs are completed during the third and fourth years and are nothing more than clinical rotations performed at an AF base hospital. The only difference between this and an "away" clinical rotation at a civilian hospital other than your medical school is that the AF pays for everything (including travel and housing expenses) and gives you active duty pay (approximately double the monthly stipend). On the other hand, fellow students who want to "experience" another hospital have to pay for their own travel, housing, food, and any other expenses they might incur. Getting away from your medical school for these rotations is typically straightforward; most schools are extremely cooperative, and if it is impossible for some reason, other arrangements can likely be made. These rotations are opportunities for students to not only get hands-on experience in the AF medical system, but also to make a name for themselves, get to know doctors in the AF, and become familiar with different residency programs available. All clerkships must be arranged 90 days in advance; contact information is available at the HPSP Home Page.

Application to Residency and the Military Match.

The next commitment: the mandatory residency application. This can be confusing, so bear with me. At the end of the third year, HPSP students download an application packet for the AF residency program. For those interested, this link is to a copy of the USAF HPSP 2002 GME Application that I used. (The Army and Navy currently use the Electronic Residency Application Service (ERAS), which is also used for the civilian match.) When this time comes, students have the opportunity to apply for the AF residency programs and/or apply for a civilian deferment. If the AF has the residency program a student wants, he or she can include that program on the list and rank it with other AF residencies that seem appealing, similar to the normal civilian process. If a student wants a residency not offered at an AF hospital, then he or she can rank a civilian deferment as the first choice. A "civilian deferment" means the AF has given permission for a student to apply to a civilian program in a given specialty and go through the normal match process via the National Residency Match Program (NRMP). Once that student is accepted to a civilian program, he or she will not have any military responsibilities until the residency is complete.

This process is much earlier than the normal residency application process. The military application is due in mid-September of the fourth year of medical school, whereas civilian applications are accepted from September through November for most programs. During the summer and early fall, students must interview (either by phone or in person) with each AF residency director in the specialty of choice. The results of the military match come out in late December, in the middle of civilian interview season, so some students have the AF match results before ever having to worry about interviewing for civilian residency positions. However, many (like myself) still apply to the civilian match and begin interviewing in November and December before getting these results. Those that apply to civilian residency programs, but match with an AF residency are absolutely required to withdraw from the civilian match.

Active Duty "Payback".

After the residency, internships, and fellowships, comes the active duty commitment. Now the AF has four years’ access to a full-fledged doctor, certified in his or her specialty. Most people will be stationed at a base hospital within the Continental United States. HOWEVER, be aware that you still may get sent overseas during your three or four year commitment! You will be stationed within the continental US, but during every 15 month period, there is a three month window during which time you may get sent just about anywhere on Earth. You may not get sent anywhere during your "window", but you will probably get shipped out at some point during your payback and be gone for three to six months. This can be a great experience, but for those with family it may be particularly difficult, because they often do not get to come along (so-called unaccompanied assignments). Getting permanently stationed "overseas" is rare unless requested, and these slots are usually offered to physicians with prior service or "time in the field".

As far as the choice of station location is concerned, each person can rank his or her preferences for base assignments, but ultimately the decision is up to the AF. The true odds of getting a top choice is impossible to know, but the assignments are definitely based on AF need. I know some physicians have been sorely disappointed by assignments to active duty locations low or not even on their "wish list", something they tell you will "never" happen. I found this list of Assignment Possibilities from an Air Force website and edited it down to the key points. It provides information about each AF hospital including location, size, website links, and the available specialties (meaning the specialists assigned there). This information is likely dated because of the constant changes in the AF healthcare system and should definitely not be used to make specialty decisions, but it is still interesting to consider.

The Reserve: Life After Active Duty.

Ah yes, then comes the issue of reserve duty. This obligation is a point of confusion for many HPSP recipients (including myself) and notoriously poorly explained by recruiters. Previously, I stated on this website that the resesrve duty is served consecutively with medical school, but I stand corrected. During medical school HPSP students are on reserve status, however, this doesn't count toward fulfilling the reserve duty commitment. The years during residency (either civilian or military) apparently do not count toward this requirement either. (As an aside, I have heard this detail is a point of significant contention. All HPSP residents are either reserve or active duty status, and this technically satisfies the contractual obligation. Moreover, civilian residents on reserve can and have been called to active duty during their residency. I have not heard the final word here, but would appreciate information from anyone who knows more.)

The safest assumption is that you will go directly to reserve duty following your active duty service. Again, I highly recommend read your contract and get a clear explanation from your recruiter what your reserve duty committment is and when that time is served. Also remember, with every extra year of service (see below) you acquire, you also acquire an additional year of service in the reserves.

These years are served as part of the Individual Ready Reserve (IRR). Traditionally, IRR is thought of as being benign as doctors are only called to active duty in extreme circumstances, i.e. a military crisis such as war. During the Gulf War and the more recent war in Iraq some physicians have been called up, so it is definitely a point to keep in mind when signing the contract. This is especially important if you think you might be involved with a private practice where it would be difficult to leave and find appropriate coverage for your patients. For many, though, this is the time when HPSP doctors get on with their lives in the outside world. What they do is not restricted by the AF, so they can start their own practice, get into a partnership, go to a hospital, or even serve a few more years with the AF. In fact, some physicians do decide to continue on active duty until the reserve commitment is satisfied.

The Fine Print and Other Details.

Extra Years of Service. Everyone should also be aware of an often overlooked stipulation in the HPSP contract stating that extra years of active duty and reserve duty commitment may be incurred with extended AF residencies—this does not apply to civilian residencies. For a four-year scholarship, every year over five years of an AF residency adds one year to the active duty and one year to the reserve duty commitment once the residency is completed. This means that a five-year general surgery or three year family practice residency with the AF does not add any years to the commitment, but a longer residency of six or more years that is done through the AF will add one or more years to the commitment. I don’t know why this is the way it is, but for the most part I don’t see it as something to worry about. Most residencies offered by the AF are five years or less; many six-year-plus residencies, such as certain surgical specialties, are only offered via civilian residency programs, requiring an AF deferment, but not involving added commitment in the end. This may become a factor when seeking fellowship training, which also counts in this equation. An individual with a three-year scholarship should be acutely aware of this stipulation, however, since a five year military residency (such has surgery) will translate into an added year of active duty plus a year in the reserves after the active duty commitment is complete--a nice deal for the AF since they only pay for three years of medical school.

Stop Loss and Extended Contracts. I have also learned that the military reserves the right to put all contracts on hold in times of crisis to prevent loss of personnel, as with the attacks of September 11. At that time, as I've been told, some AF physicians were unable to leave the AF, despite serving out their contract. One of the big consequences of this may be lost job opportunities with civilian practices or hospitals, simply because they can't leave the AF until this situation is resolved. Whether this will be a concern a few weeks or a few years from now is anyone's guess, but it is something to keep in mind.

Promotions for Doctors. One other thing that may be useful to know is that the promotion system is different from line officers. Doctors are never First Lieutenants, but are automatically promoted to Captain upon successful completion of medical school and after passing the USMLE Steps 1 and 2. Promotion to Major is automatic after five or six years, including years of residency training. Promotion to Lt Col is also automatic after enough years of active duty. Promotion to Colonel is competitive at all levels and is based on a few factors: excellence as a physician, level of responsibility within the clinic/organization, leadership potential, performance in additional duties, and completion of professional military education courses.

Retirement. Another consideration is that twenty years from the start of Active Duty or the beginning of an Air Force Residency, members are eligible for retirement benefits. What this means is that if you leave the AF after 19 years and 11 months of service, you get zero in retirement benefits; you have to be active for the full twenty years to qualify. Being able to retire after 20 years is considered by some to be a nice benefit to AF medicine. However, the second thing to know about retirement is that only a portion of your pay (base pay) will count when calculating your retirement benefits. Doctors make a lot of specialty pay that is not included as part of the retirement package. Time to retirement may be different if you have prior service.

Frequently Asked Questions.

FAQ #1: Why did you choose the Air Force over the Army or Navy?

I pretty much tell people the same thing when they ask why AF over Army or Navy. They all have the same scholarship, essentially, and I had classmates in both the Army and Navy who were very pleased with their scholarships/branches. I would never tell anyone not to join a particular branch. Personally, I nixed the Navy immediately because I have no interest in spending time at sea (it's as simple as that). The Army is good, but the Air Force recruiters had a better sell and caught me at the right time. They literally called me out of the blue the moment I was thinking about a military scholarship, so I said what the heck and let them talk to me for a while and applied and got the scholarship and here I am. Overall the AF has always made a good impression on me, and I have to say that impression has been upheld through my training and active duty time with AF doctors and fellow AF HPSP students. The AF is the only branch I applied to and I got the scholarship, but for some people the decision is based on which branch awards them the scholarship, since it is competitive. So what it may come down to is necessity, because that's the only scholarship you get, or personal preference based on family members, the experiences of people like me, or your gut feeling. (It might be interesting to ask the recruiters why you should go with their branch over the others--they probably have a stronger opinion than me. Of course, recruiting isn't my job, so that might play into things.)

FAQ #2: Why didn't you go to USUHS (Uniformed Services University of the Health Sciences)?

I hadn't even heard of USUHS until I went to officer's training and met some of the participants. Fortunately I don't think I missed out on anything; this did not sound like an appealing option for me, primarily because of the long-term commitment. I like HPSP because it is a relatively short-term commitment. I could not justify, for myself, committing any more time than that unless I knew exactly what I was getting into and I don't think anyone can predict what the situation will be that many years in the future. Additionally, I won't have to enter the military lifestyle for several years (even longer with a civilian residency), not that it is such a big deal to wear a uniform. USUHS students are essentially on active duty as soon as they enter medical school and for the next 7 to who-knows-how-many-years of their lives after that (depending on how long their post-grad education is; they all have to do military residencies and may owe more time as I describe above). I believe that USUHS students get paid substantially more than HPSP students during medical school. That is, officer's active duty base pay versus the HPSP monthly stipend. It is about 2-3X more money. This is a major benefit. If I were certain that I wanted to make military medicine my career, then USUHS would have been a great option for me. However, I still want the freedom to practice in a civilian setting if my four years of duty are a bad experience. And if this is a great experience I will likely have the option of extending my contract with the AF, so it is win-win as far as I can tell.

My advice if you're thinking about HPSP versus USUHS: Take a look at the medical schools you get into, as well as USUHS and ask yourself where you'd be happiest. This may be the best route to help you decide--if you definitely like one of the civilian schools better, then take the HPSP scholarship. If you like USUHS better for your medical education, then go with that. This is probably what I would do in the end, and is definitely what I did when I was choosing HPSP and my school. I would suggest finding someone who is in USUHS now AND someone who has already been through the program to help you make a more informed decision. I know that can be tough, but it's the only way to get the answers you want!

FAQ #3: Will the Air Force restrict my choices for residency?

This was one of my greatest concerns with the scholarship. From what we are told, the chance of someone not being able to do what he or she wants is very slim, but I am skeptical. I decided (in my infinite wisdom) that I could handle the worst-case scenario of ending up as a general medical officer (GMO--this is what you can be right after your internship year of residency) for four years if it came down to it, and then later follow-up with the residency I wanted to do. Everyone needs to be aware of the risk and weigh this against all the positive aspects of the scholarship and being affiliated with the US military. (By no means do I want to imply that being a GMO or Flight Surgeon is the end of the world. In fact, I have met many physicians who served in this capacity and enjoyed the experience thoroughly and thought those few years were very well spent.)

In reality, getting into a civilian residency can be very competitive--getting into a residency through the military can be EXTREMELY competitive. Again, this is partially based on the needs of the military and may be more or less competitive depending on how many OB/GYNs or internists or whatever doctor they need in a given year and how many students apply. For some specialties, there have been as many as four applicants to one spot. This means a significant number of people were disappointed to not get their first choice for residency training. Rule of thumb is that the competitive civilian residency specialties are even more difficult to get in the military. On the flip side, for less competitive residencies, the AF has to fill all of their residency spots (at military hospitals) in the respective fields before they'll let anyone take a civilian spot. So, if you want a civilian deferment for a residency that doesn't even fill all the AF hospital spots, you'll be denied the civilian deferment and forced to do a military residency. (In general, the Air Force offers many more civilian deferments than either the Army or Navy, depending on specialty.)

The key point to understand here is that the AF doesn’t have to say yes to what you want, which is a big consideration if someone has his or her heart set on a particular specialty or location. They try to match HPSP students to different specialties based on the needs of the AF, which means that HPSP students are in competition with one another for a limited number of positions. In other words, when you apply, the AF may not need another neurosurgeon subspecializing in the pineal gland, so if you put that as your first choice, you’re probably not going to get it and will have to settle for something else. The word is that 95% get their first choice and 98% get their first or second choice. I personally find these numbers very difficult to believe, and think 85 to 90% probably get their first choice. Some are likely deterred from applying for competitive residencies based on the number of spots available as well, distorting the percentages somewhat. In reality, very few medical students applying for residency have a "true" second choice, so the 98% above is almost irrelevant. I like to say that if you do well in school, all doors will be open to you, including the residency of your choice. This is definitely true in the civilian world, but will only take you part of the way in the military--the rest is truly up to them.

Additionally, not all residencies/subspecialties are going to be available the year you apply and what is offered varies from year to year. It's tough to guess, so if you have your heart set on an unusual or highly competitive residency be very conscious of this when deciding whether or not to take the scholarship! For an idea of the residencies offered, here is a link to the Specialties Table for clerkships and residencies and a document containing the Medical Corps Approved Training Starts for 2001 (residencies and fellowships people are actually doing and the number of spots approved by the AF). I copied both from the HPSP Home Page. The copies linked here are out of date, but should offer a general picture of things. The "Integrated Forecast Board" releases the latter list every June after they have determined how many of each doctor they will need over the next few years. The projections for each specialty field are typically based on the number of physicians currently in practice with consideration for the number entering/leaving the Air Force over time. If a particular specialty is not approved by the IFB the year you apply for residency, it means they do not need any new personnel in that specialty and it will be virtually impossible to train in that capacity.

FAQ #4: Will I be able to do a fellowship?

Like residency, military fellowships are competitive. When it is time to apply for fellowship, each resident must again fill-out the standard application and participate in the military match. There are definitely fewer fellowship positions than desired and people are denied this additional training every year. Anyone can apply for fellowship training, but the AF is very blunt about who is given preference for these spots: people with "field experience". These are the individuals who have spent time as GMOs or Flight Surgeons and have seen active duty time before completing a residency. While not always the case, they typically owe more years of service and many plan on military careers. Obviously this policy may turn out a better investment for the military, which is why it is in place. That said, many residents still get the fellowship of their choice. Moreover, if denied a fellowship (and depending on your field), four years of experience as a practicing physician with the military may be of equal or greater value when searching for a new job or applying for further training once the commitment is complete.

FAQ #5: How do the AF residencies compare to the civilian ones?

This is a difficult question to answer, having never been a part of a military or civilian program (yet), but I do have some insights from others. The best answer is that some are excellent, some average, and others dismal, and there is no way to tell what they will be like several years from now. I have personally seen the full range of military resident satisfaction. Some residents believe they are getting top-notch training and are ecstatic about their situation. Others are miserable and resentful that they were stuck in a military hospital for residency. In other words, the military residents seem to have the exact same range of emotions that I have seen in residents at civilian hospitals. Some will be satisfied, others disappointed--this is true anywhere. However, the concerns are real and often revolve around things like the quality of the facilities, lack of variety in cases, too few procedures or cases, cutbacks in military healthcare spending, etc. For example, some hospitals have experienced significant downsizing (literally hundreds of beds lost), yet still train the same number of residents. In other situations, certain patients are being referred to civilian hospitals for care; residents may lose the experience of treating these patients. Those training in surgical specialties seem to have some of the biggest complaints, whereas people training in primary care seem most satisfied, overall. Some military hospitals have combined with one another or outside civilian programs to help maintain the quality of resident training, but whether this is truly effective, I don't know.

Often people promoting this scholarship will emphasize the benefits of military residency programs such as good pay and good hours. It is true that military residents earn, on average, more than other residents on the order of several thousand dollars per year. The hours issue is less clear. In some locations, there isn't as much work, others there may be a lot to do every day and the military residents work "normal" resident hours (80 hrs/wk). The same variability can be seen among the civilian residency programs as well. Recently, a national cap was placed on working hours for residents at 80 hours/week. New York state has had this law in effect for years under the "Bell Commission", but when I joined the Air Force, the military was one of the only other "institutions" that had a similar cap on hours. Now, to boast about that 80 hour cap is irrelevant since all institutions need to comply as of Summer 2003. Also realize, that seeing a lot of cases and working "long" hours is going to be vital to the learning experience of most residency programs, so a cush residency may not be the best one.

Having gone through the residency application and interview process for both the military and civilian matches, I still don't know how to objectively compare one residency to another. I suggest that, if you are interested in a particular military residency, you look into a residency program guide such as the Green Book or Freida Online for additional information and names of program directors if specific residency questions arise (though you should probably have a good reason to call a program director). Additionally, do your best to talk to some military residents in your field of choice--they will provide you with some of the most useful information.

FAQ #6: I'm not really interested in the military, but I need the cash. Is the scholarship worth it?

ABSOLUTELY NOT. Do not accept or even apply for this scholarship if you have zero interest in being a part of the military. More likely than not, you will be bitter and disappointed with the experience. Military life is not easy, the scholarship is not a "free ride", and military medicine is definitely not the place to make money. If you do not enjoy the thought of serving the country as a military physician (with the military first), the money will never make-up for the sacrifices and uncertainties involved during your few years of commitment. Please understand this: most doctors (even those who have to take personal loans for everything) will be able to pay off their debts--eventually. When you look at the average starting salaries for most doctors you should be convinced of this.

Personally, the money was not such a big deal for me. However, as much as I’d like to sit here and tell you that the money had nothing to do with it, that’s just not the case. My parents had paid for all but $2,000 of my undergraduate education. As far as paying for medical school, they were willing to help me out and probably could have loaned me half of the cash; I would have swallowed the rest in loans. With tuition and expenses around $40,000+ per year, I probably would have cost my parents about $80,000 over four years and amassed a debt around $100,000+ to call my own. Not bad at all. Personally, though, I never want to have a debt hanging over my head no matter how big or small. I haven't had to pinch every penny over the past few years. I don’t have to stress about the interest building on unsubsidized loans while I am making minimum wage during my residency. I will never have to budget for my loans while I am a practicing physician. All of these considerations played a role in my decision.

FAQ #7: I'm thinking about going to an inexpensive/state supported medical school. Is the scholarship worth it?

I have to say that you had better have a really good reason to join the AF or military if you're going to attend an inexpensive/state school (I'd say that anyway, but especially in this case). I can tell you right now the AF is salivating thinking that you might go to a state funded school. It's a huge bargain for them. I knew one woman at Buffalo (which is state tuition) who came to the realization around her fourth year of medical school that the AF was getting a hell of a deal with her and that it almost would have been easier to take out loans. However, she did particularly enjoy being in the AF and was highly motivated to be an AF doctor, so she was still happy. I'm happy with my experience with the AF so far and don't regret joining, but I can honestly say that I would not have joined if my tuition were state supported. I mean, $60,000 in loans is a lot of money, but $120,000+ is a hell of a lot of money (to me). But I would have been glad to budget myself to pay off state tuition, rather than devote 4 years to the AF and have so much uncertainty about residencies and where I'll be stationed and everything else. That's just what I would have done.

If your medical school has reasonable tuition, but you still really want to spend some time in the military, you may want to consider the Financial Assistance Program (FAP) offered by the Air Force, Army, and Navy. Instead of getting money during medical school and having to go through the military match and worry about getting the residency you want, you sign up for FAP after you get accepted to a civilian residency program. This way you get to do your specialty of choice, no questions. While in residency, you get paid by the program you're at plus you get a military bonus: a monthly stipend of about $1,000 and approximately $20,000 per year to use to pay back your debts or just spend as you please. You could earn $70,000 - $80,000 per year during your residency and fellowship. If the additional ~$30,000 is considerably more than your school's tuition, then it may be a great deal. In return (for FAP) you owe year-for-year of residency, plus one. Unfortunately, my knowledge of FAP has reached its limit--hopefully you'll be able to find other resources to more fully describe this opportunity. The AAMC has an excellent online guide to managing debt at their website that provides some information on FAP and other "payback" programs such as National Health Service Corps (NHSC) and National Institutes of Health (NIH) Loan Repayment Programs. Everyone should look at this to help determine the best way to finance a medical education; you may be surprised by some of the options.

FAQ #8: Is the monthly stipend enough?

This depends entirely on where you live and what housing/living expenses are like. Rochester was a relatively cheap place to live (I paid about $320/month rent plus $50-$150/month in utilities in a three person house), but I still needed a little cash at times (well under $2,000) to cover some other expenses over the past few years. If you live in a place like New York City and areas of CA you will need extra money, no doubt, but should easily find loans to cover those expenses through your medical school. The stipend is over $1,000/month now and in most cases will be enough, but just barely if you're not careful about money. Having a budget is probably the most important thing to do if you want the stipend to last.

FAQ #9: How much will I really make as a military doctor?

I have avoided this question for some time because I did not have an accurate answer, but everyone wants to know so I did my best to find out. From what I have learned, you can expect the range to be approximately $75,000 - $140,000 per year, +/- a few thousand dollars. The lower end of the range is estimated from a Flight Surgeon or Family Practitioner's pay (starting) with the upper end based on an OB/GYN or Radiologist's pay (with a few years of service). It is difficult to determine the exact pay you will earn for each specialty in advance, but it does correlate with civilian salaries and increases with years of service. Overall, the lower-paying fields are more comparable to civilian earnings, whereas individuals in higher paying fields may (potentially) earn 50%+ less when compared to some private practice settings. The military does, however, seem to pay as well as many academic centers and (depending on location and field) offers similar academic opportunities.

For those interested, physicians qualify for a number of special pays, in addition to the base pay received by all Air Force members. These are:

Variable Special Pay (VSP): an amount paid monthly, in addition to your base pay.
Board Certification Pay (BCP): an amount paid monthly to board certified physicians.
Additional Special Pay (ASP): an annual bonus paid to all physicians not in internship or initial residency training. The amount of the bonus is the same for all physician specialties.
Incentive Special Pay (ISP): an annual bonus paid to physicians based on their specialty training.
Multiyear Special Pay (MSP): an annual bonus paid to physicians electing to sign multi-year contracts.

FAQ #10: What are the chances of being pulled from medical school or residency during times of war?

Slim, but not zero. So far, I have not heard of any medical student in any situation from any branch being called to active duty for the sake of war. Ultimately, medical students do not have any valuable (military) skills; it is only after we become doctors that we run the small (but real) risk of getting called to active duty. During the Gulf War, approximately 40 out of ~750 civilian Army residents were called to active duty. The report I read did not specify what year they were in residency or what specialties they were training in. However, this was a 5% overall risk of being pulled from the program to be completed at a later date. I did not see any data from the Air Force or Navy and couldn't even estimate what might have happened with these residents. Experienced physicians have told me that the Air Force "doesn't do that" to their residents, so perhaps none of them were called to duty. During the Gulf War there were over 1,000 Army residents training at Army facilities and only about 20 of them were called to duty--instead of stripping the Army hospitals of residents, they did it to civilian programs. I've also been informed that residents have been "pulled" to serve during the recent conflict in Iraq, but don't have any numbers.

FAQ #11: Am I good enough to get into medical school and/or get this scholarship?

You never know until you try. Honestly, I've never been on a medical school admissions committee or judged the quality of HPSP candidates. I know the kind of person I would choose and could give you an outline, but I'm not the one making the decisions! Therefore, I will refrain from giving advice beyond pointing you in the direction of those more qualified to give it: talk to your institution's medical careers advisor regarding the medical school application process. If that doesn't work, look to a mentor in the medical field or your student advisor. You may also want to read about the application process and get additional information on individual medical schools. There are many books published on these subjects. Some you may want to start with include: Medical School Admission Requirements: United States and Canada -- by Association of American Medical Colleges, et al; Complete Book of Medical Schools, 2003 (Princeton Review) -- by Malaika Stoll; and Getting into Medical School by Sanford J. Brown, MD. I don't necessarily endorse any of these books and haven't looked at them in years, but they may prove useful. And as for being competitive for HPSP: if you are competitive for medical school, then you are certainly competitive enough to at least apply for the scholarship.

FAQ #12: So what's happening with you now?

For those interested, this is what is happening with my medical career. I decided to go into radiology and applied for residency per usual through the AF and civilian matches. After interviewing, I decided that the radiology program at Wilford Hall in San Antonio, TX would be a great place for me and ranked it as my first choice. Civilian deferment was my second choice, with the Travis AFB program in California as my third choice. (Wilford Hall and Travis are the only two AF radiology residency programs.) I found the Air Force Match to be one of the most anxiety-provoking experiences of medical school, and that says a great deal. I applied to a VERY competitive field, and though I felt confident that I could match in a civilian program, I wasn't so sure I'd even get radiology at all with the Air Force. As it turns out, I did not match with Wilford Hall, but got my second choice of civilian deferment (so it was a good thing I had been interviewing while I waited for the AF match results). Ultimately, things couldn't have turned out better. I got my first choice for preliminary medicine year at Rochester General Hospital in Rochester, NY. I also got my first choice for radiology at Oregon Health Sciences University in Portland, OR. I graduated from the University of Rochester School of Medicine in May 2003 and had a good experience as an intern at RGH. I'm now on the West Coast enjoying an outstanding radiology program at OHSU and I couldn't ask for more. Active duty with the Air Force still looms in the future, but if it goes as well as everything has so far, then I will have nothing to complain about. Let's hope the trend of good fortune continues . . .

This is where I tell you I made the right decision.

During my senior year of college, I went through the typical medical school application process and was lucky enough to get my first acceptance by the middle of October. That early letter took a lot of pressure off of the situation. However, it left me with more time during the fall to think about other important issues that most pre-meds think about later down the line. Not least of these "issues" was the cost of medical school. This was not something that I wanted to think about while I was still interviewing, working on my honors project, and trying to keep the grades going for the rest of the year, but since I wasn’t worrying about "getting in" any more, thinking about this was a natural progression.

So yes, as I said, the money was part of the issue in joining HPSP. However, there was another side to the decision. In the simplest terms, Air Force medicine appeals to me. My patients will not have to worry about how they will pay for their medical expenses, and I will not have to worry about collecting my bills or paying for malpractice insurance (which seems to be a bigger issue every day). Everything is covered by one organization: the Air Force. I won’t have to fight for a spot on an HMO’s list or think about whether a certain procedure will be covered by the different insurance agencies or managed care programs. The Air Force wants the best care for it’s members and has taken steps to make sure that care is accessible. Granted, the Air Force medical system is in flux and it is it's own managed care organization with it's own problems, but these issues arise in any context of medical practice and seem even more frustrating to me in the civilian world.

Aside from this, I love the idea of providing care to military members and their dependents. There are thousands upon thousands of people in the Armed Forces, dedicating their lives to protecting the country. Too often we forget that these are real people who need and deserve the best medical care just like everyone else. Beyond this, we often overlook the fact that these people have families who are also in need of quality medical attention. So I will not only be caring for young men and women, but for people in all age groups from newborns to the elderly. The challenges inherent in caring for this group definitely match and possibly exceed those found in civilian medicine, especially when considered in the military context.

There is also a piece of me that sees this as my duty, though this is not something to which everyone may be able to relate. I will be providing a much-needed service not only to the people I care for, but to the country as I help my patients do their jobs. I feel that every doctor (whether he or she likes it or not) has a responsibility to use his or her abilities for the good of society. Some doctors find cures for deadly disease, others care for the homeless, and some spend time in areas lacking sufficient medical resources such as inner cities, rural areas, or reservations. For me, I will be caring for the people who protect our freedom. Many people don’t realize how much is involved in maintaining the defense of this country; I hope everyone has an experience sometime in their life that helps them appreciate the armed forces and the sacrifices military members have made in their service. It means a great deal to me to have this opportunity to give something back in a capacity that I know I can make a difference.

My reasons for joining the Air Force are reinforced daily and continue to multiply . . . yet I still find them difficult to put into words. I would say it is even more difficult to answer than the question: "Why medicine?" that we all have heard so many times. We all know the reasons, but no matter how many times we try to give an answer it never comes out quite right. I do hope what I have said here helps give you an idea of some of the things I considered important while making my decision.

If you’re still interested, here are some things you should know.

As a senior (or first year medical student if you are applying for the three year scholarship), you should contact the nearest Air Force (or Army or Navy) recruiter by mid September (the sooner the better) to start the application process, discuss the scholarship, get the necessary information, etc. This is the step to get the ball rolling. Be aware: The deadline for three year scholarship applications this year (2003) is 22 October, and the cut-off for the first four year board will be 21 January 2004. If you don't know how to find a local recruiter, try making a contact through the Air Force Recruiting Website.

After contacting a recruiter, one of the first steps in the application process is the physical exam at a nearby Military Entrance Processing Station (MEPS). When I applied, I took the physical exam after getting the scholarship, but I've been informed that all applicants must now take and pass the MEPS physical prior to submission of the application. This is a good idea, because if you are disqualified for any reason it is better to know right away. If you do have a disqualifying condition, there is a chance you may still be eligible for a medical waiver. In this case, the entire application package (including the physical exam results) must be submitted 2-3 weeks early for final approval by the Surgeon General. So, if you think you have a potentially disqualifying medical condition, the sooner you get started with the process the better. (Sorry--I don't have a list of disqualifying conditions.) At the MEPS you will most likely be exposed to the enlisted recruits, and you’ll see immediately that you are treated differently as a future officer. Remember that you are being commissioned and you should be treated well, so be sure you go for your physical on a day when they can give you the appropriate attention. Your recruiter will probably mention the red carpet treatment more than once, but be sure to go on a day when this is available. This may sound strange now, but after seeing what enlisted members go through you will understand what I mean. Again, your acceptance to the Health Professions program is contingent upon final approval for service by the Surgeon General. (Also be sure to wear sneakers and not sandals or they won't let you into the physical station.)

Before winter break, the application is due. (Again, deadlines this year are 22 October 2003 for 3-year scholarships, and 21 January 2004 for the first 4-year scholarships.) Your recruiter will know more about deadlines and will/should make sure everything gets done in a timely fashion (but being proactive doesn't hurt). He or she will send you the paperwork, discuss what you need to do to apply, and should meet with you personally to answer any questions you may have. He or she will complete the paperwork (i.e. type it up on the forms) if you provide the appropriate information. The basic application consists of a few questions very similar to other medical school applications (like a personal statement) so it shouldn’t be too tough. One of the (perhaps) most difficult questions is why you want to join the Air Force—this is something you just have to struggle with yourself, though I can think of a number of reasons the Air Force is the best way to go. Also required is a copy of your MCAT scores (this is mandatory, so be sure you know that if you’ve gotten into a school that doesn’t require the MCAT), recommendations (you can use your medical school recommendations), and an official transcript.

After submitting the application, you’ll have an interview with a commander (or relatively high-ranking officer, maybe a Captain). For me, this took place over the phone and he went rapid-fire with the questions. It didn’t take more than ten or fifteen minutes so it is important to have answers to questions ready—anticipate what he or she will ask. The interviewer may be interested in your family, what they think about you possibly joining the Air Force, if anyone you know is in the Armed Forces, what you think of the Air Force and why you want to be a part of it. Also, be prepared to repeat information included in your application essay (personal statement). Basically it is another medical school interview, so hopefully you know the general format. Again, the biggest thing is to be prepared to answer the questions. It is ok to think before spouting an answer, but try not to say you don’t know without a good reason. If you really don’t know (i.e. don’t know what kind of doctor you want to be), then just be ready to have an explanation. You should absolutely have an answer to why you want to join the Air Force—this cannot be an "I don’t know" answer.

Now you have to wait. Your recruiter will be in touch with you to get some last minute information and to keep you up-to-date. It is a good idea to know the most expensive school you applied to and how much the tuition costs. This doesn’t hurt or help your chances of getting the scholarship, but does put a cap on the tuition of the school you eventually choose (i.e. you can choose a less expensive school, but not more expensive).

If you get the scholarship (you will find out sometime in the spring, probably March) you don’t have to accept immediately. The deadline for me was April 15 because the Air Force had to start preparing their finances for the next year and include your tuition as part of the plan. If you know you want to do this, accept immediately and get commissioned as soon as possible. An earlier commissioning date will help you down the line as far as pay is concerned, even though the difference will only be a matter of weeks.

Following your final acceptance is your commissioning. After you are commissioned, you should be sure to make arrangements with your recruiter for Commissioned Officer’s Training, which I discussed above.

Final Note.

The Health Professions Scholarship Program is a big commitment and a major life decision. Medical school applications and interviews are a heavy load to handle on their own—to have to think about your life several years in the future can be a nearly impossible thing when you just want to get through the next couple of months. I hope if you are considering a military scholarship for medical school that what I have written helps put things into perspective and provides you with some useful information to make the decision easier. Please feel free to email me if you found this helpful, with questions you may have, or if you think I may be able to help you in some way. Include the subject heading "AFHPSP" and I will be more likely to get back to you. Best of luck.

Luke Ballard, M.D., Captain, USAF MC
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