Was it worth it?

When everything is said and done, my last update on this website will be on this page. As I write this, I am three months into my first job out of residency and I thought it would be a good time to reflect on how my HPSP experience has been. I plan to make an update after any significant changes in my Army life (deployment, PCS, decision to leave, etc). This is going to be the most "bloggy" page I will make, so if you're into that, dig in!

First attending position (Written November 2022)

As I discussed on the Your First Job page, I did not receive the position that I had requested. It was a hard hit at first having to give up on the plans I had made after getting a 1:1 match with the position I had wanted most. Once I got through the five stages of grief, I started planning for my new future. I bought a house 5000 miles away sight unseen, got my family situated, and prepared myself for Army life. As things tend to go, almost everything has been better than expected. The brigade to which I had been assigned was just about to return from a deployment as I arrived, so I had no looming assignments, unlike many of my co-residents. My day-to-day work is dramatically less stressful than in residency. Being Family Medicine, in residency, I was used to 12-hour days seeing up to 20 patients a day in clinic; my "worst" day so far, I've seen 12 in an 8 hour day. Pace of Army life is WAYYY slower than residency, overall. Again, some of my colleagues are not faring as well: some doing full-scope family medicine working 80+ hours a week.

With work a relatively small factor in life right now, I can really focus on family. I am about to have a second child and I am in a great position to get my financial life together. I regularly listen to the White Coat Investor podcast and hear about what civilian physicians go through with loans and lifestyle management. There is a lot of talk about preventing "lifestyle creep" - the tendency to want to get bigger better things when you finally get an attending salary. For me, it really hasn't been an issue. I graduated with $4000 of debt, from my wife's loans, and had already been maxing out my retirement accounts during residency. I have been able to spend all of my extra attending salary on house upgrades and it hasn't hurt a bit! I have no mountain of student debt on my back and my retirement accounts have already been set in order. I could not have achieved either of these things at a civilian program where I would have graduated with debt and made half of what I did during residency. With my house spending dying down, I plan to achieve my New Years' resolution in January: start on my kids' 529 plans and UTMA accounts.

With all of this in mind, at this point, the HPSP has been WELL worth it. While my med school friends are almost certainly making more money, I have almost no debt and have far more invested in my retirement than they could. I have an awesome house, drive a new car, and have a chill job. I am very debt-averse, so I know that had I taken on a few hundred thousand dollars of debt, I would be living in a shack, biking to work, and throwing 90% of my salary at my loans for the next several years. Instead, I have a comfortable life for me and my family, and money is the last thing on my mind, which for many, is priceless. 

In all of this paradise, there are certainly storms on the horizon: "taskers," meetings, 0600 random urinalyses, training events, and a deployment in early 2024. These will almost certainly be somewhat of a downer, to say the least, but I am hopeful that as always, things will turn out better than expected and I will be sure to let you know how they go.

Was it financially worth it? (written November 2023)

One of the biggest considerations of this scholarship is the financial benefit - did this pay off better than taking out loans? The answer has two components: the ADSO and beyond. 

For me, the answer is easy: 

1) The Four-Year Payback (ADSO - Active Duty Service Obligation)

My medical school cost approximately $60k per year. I received about $2k a month in stipend. You factor in textbooks and various other expenses we can be generous and round up to $90k a year of scholarship for four years. Even for a fledgling Family Medicine physician, making around $150k a year is on the lower end of compensation. However, if you add in $90k of loan payback per year, I am basically making $240k a year as a brand-new primary care physician, which is stellar! This is not even considering the interest of the loans I would have had, the significantly higher pay you receive during residency, or any of the other benefits of being in the military such as unlimited high-quality healthcare, thousands of dollars a year in credit card benefits, etc. If you factor in all of the other perks of being in the Army, my compensation is easily valued at around $275k. For any primary care physician, the HPSP is an easy financial sell. If you plan to go into a specialized surgical field where you can make in the mid-upper 6 figures, this is a far less viable option and the decision is much more individualized.

2) The Beyond

You've been counting the days and your freedom date approaches... what do you do? Do you continue the job you have? Maybe progress up the administrative ladder? Clinic/department chief? Or do you hightail it out of there and never look back! Financially, the answer is easy: get out ASAP! Remember that extra $90k a year of student loan payback you were hypothetically receiving? Yeah, that's gone. You are an O-4 with at least 7 years of service making around $160k-170k per year (depending on BAH and COLA; and including benefits, you may consider your total compensation somewhere around $200k). Also, the Army has not increased specialty pay in decades.

You have another choice: take a retention bonus for 2, 3, 4, or 6 years OR stick around year-to-year giving you substantial negotiating power when it comes to your duty station and job (you want me to stay? Fine, I want to be stationed at Disney world and work 3 days a week!). If you take the 6-year retention bonus (the highest-paying), you will get anywhere from $50k to $130k per year, depending on your specialty. Let's start with the $50k - you are in a primary care specialty. Add this to your earlier salary estimate of $200k, which is $250k per year for primary care. Now, you are an attending going into your 5th year post-training; depending on where you live, this may be a totally reasonable salary. That said, you can get substantially more if you so choose. Speaking of choice, to get to this number, you had to give up your ultimate choice of where you live and when you get sent on taskers, TDYs, or deployments, you're showing up at work at 0600 to pee in a cup, stand on a scale, or take an ACFT (and that darned annual cyber awareness training!). 

From a primary care standpoint, it can be argued that the finances average out across the two choices, however, when it comes to anything higher-paying than primary care, the civilian grass looks much greener. Because you are some sort of specialist, you are at least at 8 years of service and that puts your base salary somewhere around $270k-$280k (if you include benefits). If you take the 6-year retention bonus, your next salary looks something like $400k per year. That sounds pretty good, however, you are some sort of subspecialist and can make that much in your sleep (literally, oftentimes). The more specialized you are, the less sense a full career in the Army makes. 

The last point that must be touched on is retirement. If you make it to 20 years, your 4 years of HPSP time get added on and you retire at 24 years of service. Your retirement payout is $61k per year (FY 2024). That's no physician salary, but if you plan to continue practicing that'll at least cover your tax liability! You are somewhere around 46-48 years old. Let's give you a reasonable life expectancy of 80 years. That places the value of retirement around $1.5M (which will go up with inflation). For primary care, that is worth 3-4 years of salary (at 20 years of experience). For a specialist, that is maybe 2-3. You can maybe retire a few years earlier knowing you have a stable income for the rest of your life (and Tricare as well!). On the other hand, in the civilian world, you would have been free to work your heart out and reach financial independence years earlier! 

As always, it is still up to you!