my future and which service academy would be the best to follow them

I'll respectfully tell you you're wrong on two key points:

1. Not sure what your specialty is but reimbursements are actually much better now in the emergency field. The amount of indigent care of "charity care" rendered is decreasing. Previously, the hospital ate the cost of that care. Why do ERs love the elderly? Because Medicare will actually pay. The best news you can give the ER is that you have insurance.

2. Fresh residency graduates absolutely make six figures, with the notable exception of many self-practicing GP/primary care (which is a fact that is highly related to the shortage thereof). The idea that the average post-residency salary is "70-90k" is a farce. Below I've listed a short sampling of average first-year placement post-resident salaries for physicians. I've listed the more common specialties, but you're free to view the whole list here: https://www.aamc.org/services/first/first_factsheets/399572/compensation.html

Anesthesiology $276,000
Cardiology: Noninvasive $256,250
Dermatology $358,750
Emergency Medicine $230,629
Family Practice (w/OB) $161,000
Hospitalist: Internal Medicine $200,000
Infectious Disease $132,500
Internal Medicine: General $180,000
Neurology $237,500
OB/GYN: General $220,000
Ophthalmology $185,000
Ortho Surgery: General $419,439
Pediatrics: General $160,000
Radiology: Diagnostic $200,000
Surgery: General $275,000
Urology $300,000

I do not, however, dispute your comments about the hours and weekends/holidays. Full disclosure, my spouse is a physician. In her first year she made almost twice the national average for the specialty.

:) internal medicine group practice for 20 years. these numbers are so skewed. you wont get $180k joining an internal medicine group coming out of residency in a decent/good area around here because of competition and desirability of location. you might get something close in some underserved areas of the US because of the lack of and they have to make it attractive enough to practice there. i have a friend in south texas near mexico making a killing there because of that. there are always specialties that will demand more than others obviously. i say put this issue on hold and lets get back to it in 10 years ok? i hopefully can retire and find something less stressful by then.
 
^ my girlfriend's family is all doctors/nurses, and they preach rural medicine for both the money and opportunity. University of West Virginia's OD/MD (forgot which) rural medicine program is, comparatively, on it's hands and knees begging for applicants.
 
^ my girlfriend's family is all doctors/nurses, and they preach rural medicine for both the money and opportunity. University of West Virginia's OD/MD (forgot which) rural medicine program is, comparatively, on it's hands and knees begging for applicants.

yes this is so true. most of my friends that went to rural "wherever" are doing so, so, so much better than me in those terms. i, however, did not want to drive an hour to get to the nearest best buy or mall or take a plane or train to watch a show/play (ok i was spoiled). i found that the things that mattered when you were in your late 20s and fresh out of residency don't matter as much anymore 20 years later LOL. these days, i'm happy to go home, put my feet up and watch netflix with my kids and go on amazon to shop (and spend way too much time on SAF.) damn, i am getting old. thanks for allowing me to vent. :)
 
Just want to make some clarifications so people who find this in the future don't get some bad gouge

the dean of the med school got up and told the students, that while it's attractive to have their tuition paid for, that the services will control where they go to their residencies.
This is absolutely 100% correct. They will also potentially control what specialties are available. For example, for many years the Navy did not train anyone in Physical Medicine & Rehabilitation (PM&R). If someone wanted to do that specialty they were out of luck if they were in the Navy.

In addition, the dean has to include in his recommendations to residency programs that the med student is a member of the military and may be yanked out of the residency program, if the service branch decides that they need them for something.
This is incorrect. Yes, there is a letter that is included with residency applications called, get ready for it... The Dean's Letter :) It would include that the person is on a military scholarship; however, it would not include that the member "may be yanked out of the residency program" as that isn't true. Sure, if World War 3 broke out, then all bets are off, but members in residency are essentially in a protected class.


the prospects of that possibility freaks out the residency programs and often they will not accept the military med school grad
Personally I have only seen positives from residency program directors in regards to military members. For those who come with funding the programs love us as we are essentially free labor. For those who come without funding the programs "know" a bit more about the person they are taking on given the usually positives associated with people who sign up for the military.

(assuming that the grad is not going to the few military hospitals, which have very few residency spots.)
The military hospitals actually have quite a number of spots available. Yes, they aren't as numerous as the number around the country, but there also aren't as many people competing for those spots. The Air Force is the most egregious in having more medical students than intern/residency spots, but that number isn't higher than maybe a few dozen.

This has recently happened to someone I know and it was devastating to a very capable and talented med student.
I won't rain on anyone's parade, but the best applicants don't go unselected....not to be harsh but residency selection is a crazy competitive selection process except for some of the less competitive specialties, but even then it can vary by year & location.

Their choices are then to do a transition year and hope 1. that they get a residency at a military hospital the next year, 2. switch to another speciality that has more spots for residency (but is maybe something you don't want to do) or take a chance reapplying to civilian programs next year with the same language in the dean's letter to the programs.
Residency selection amongst HPSP folks is a little backwards at times. The explanation you have is close. First, the person is obviously a 4th year medical student who went through the military match in December. Sounds like they did not match their desired specialty and instead was given a 1 year deferment. I'm going to assume this person is Air Force as they are essentially the only Service that does it this way. Now, since the military match happens in December the person then had to go interview around the country to find an intern year program for the upcoming "regular (ie civilian)" residency match which just occurred in March. The Dean's Letter is the same for every match and every year. It doesn't change depending on where one applies as it is very "cold" and objective. So the same letter will be what this person gets for the rest of his life. (except after 4th year ends they will add the info from 4th year). So now this person is stuck re-applying next year for the same two matches. Since they only got a 1 year deferment from the military come next December another Board result will come out identifying if that person has been selected for one of the military residencies or has possibly, unlikely, been granted a deferment to complete the remainder of residency as a civilian. (I say unlikely as normally if the Service wants someone to complete a residency as a civilian they will be given a full deferment the first time around) OR if not selected for either of those options the person will end up serving as a General Medical Officer for a handful of years. (This is AF specific, GMO's work a little different in Army/Navy Land).

So, there is no "take a chance on" applying to civilian programs again next year. The military either will or will not allow that come December. If the military gives him a deferment then the Dean's Letter is not going to be the hold up on getting into residency. Reality is that he will very likely be a GMO after next year is over. If he is Air Force his destiny has almost certainly already been decided in that regard if he only got a 1 year deferment.

Wow, okay, that became way longer than I meant. Essentially, yes, the military owns you once you sign the dotted line. They will tell you if you can apply to civilian residency programs or not (I have done both in my training pipeline). They can also send you to a civilian program for a year and then have you complete the rest within the military system. The Dean's Letter will not be a Scarlet Letter if you are in one of the military programs.
 
Thank you all for your comments. Necessary or not, they showed to be helpful. I entirely forgot to mention that I wanted to serve the country through the military far more than I would enjoy any other profession. If it was up to me, I wouldn't pick a major at West Point and I would just go to the school and move onto being an army officer. I'm just trying to explore possible majors at West Point. Does anyone else have other suggestions?
 
Thank you all for your comments. Necessary or not, they showed to be helpful. I entirely forgot to mention that I wanted to serve the country through the military far more than I would enjoy any other profession. If it was up to me, I wouldn't pick a major at West Point and I would just go to the school and move onto being an army officer. I'm just trying to explore possible majors at West Point. Does anyone else have other suggestions?

My suggestion is to select a major that interests you and has potential for a solid post-military career should you get out after your initial obligation. The problem, as I see it, is most kids have an extraordinarily limited grasp of career opportunities in and out of the military. If they're good at math and science, they tend to self-select as premed (science) or engineering majors. If you have a true interest in serving as an officer, choose an academic area that interests you and that you can be successful in, and then wait to see how your career plays out. You can always attend grad school down the road in a more specialized field to jumpstart a second career.
 
+10
and also to any medical school interview and you won't get a second look.
I agree with many of the things stated. As a physician 18 years into private practice, the quoted salaries by scout pilot are close to what I've seen/ heard. Of course, different parts of the country have different reimbursement rates. This was mentioned earlier with regard to rural practices. However in my experience, I've not seen or heard of "most" physicians earning 70-90k with nearly half of that going to liability insurance. The 70-90 figure may be appropriate in some locations for primary care. However, the liability insurance rate is much lower (in most states). The reimbursement rates are overall going down. Yes, hospitals are "picking up the tab" for the Medicaid patients and uninsured/exchange program enrollees, however this "gravy train" is likely to end---prior to ten years from now. Just this morning, I was getting a coffee at Einsteins and ran into an old acquaintance who is a private practice rheumatologist. He said that his group recently took in two docs who were formerly at the large academic medical center in town. Those two left the university because their new contact that was offered included a non-negotiable 20% cut in pay/benefits. Now this is just one story, and I don't know all of their personal details, but it's indicative of the times.

The best advice that I've seen offered here is that if a student is that interested in becoming a physician, go to a civilian college. If you take advantage of the military scholarship, yes, they own you. While I enjoy my practice, lifestyle, call schedule (I've never heard of anyone taking call 3 out of 4 weekends per month), the fact is that things already have changed and are continuing to change.

Sorry for the lengthy post.
 
Folks,

While I recognize the issue of private physician pay was indirectly raised by the OP, let's keep this thread on the topic of military medicine/engineering. If you want to discuss private medical practice, please move the discussion to the Off Topic forum. Thanks.

Your Friendly Mod
 
Thank you all for your comments. Necessary or not, they showed to be helpful. I entirely forgot to mention that I wanted to serve the country through the military far more than I would enjoy any other profession. If it was up to me, I wouldn't pick a major at West Point and I would just go to the school and move onto being an army officer. I'm just trying to explore possible majors at West Point. Does anyone else have other suggestions?

Graduation. You will have almost two years before declaring you major. Regardless if you graduate #1 or #1000, if you graduate you become an Army officer. If you end up leaving the Army early, your major and GPA matters more or if you stay longer matters less.
 
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