Throwback Thursday Classic Post – Chapter 2 – Pathways to Becoming a Naval Physician

Posted on December 3, 2020 Updated on December 3, 2020

Note: The views expressed in this chapter are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

Special Thanks to Drs. Jami Peterson and Brett Chamberlin for their revisions of this chapter.

Introduction

The military has two programs that provide financial support for medical students and one that supports residents. The Health Professions Scholarship Program (HPSP) and Health Services Collegiate Program (HSCP) are used to attend a civilian medical school. The Financial Assistance Program (FAP) provides financial assistance to current residents. Each program provides various benefits in return for a contract serve as an active duty physician following completion of medical school or residency. Additionally, students accepted to the military’s medical school, the Uniformed Services University (USU) can earn their medical degree while serving on active duty. Alternatively, board certified physicians can apply to be a Direct Commission Officer (DCO) and begin service immediately upon commissioning.

Uniformed Services University (USU)

Established in 1972, USU trains future physicians in the unique aspects of military medicine while meeting all requirements for general medical licensure in the United States. Application to USU is through the American Medical College Application Service (AMCAS). In addition, applicants must also meet all requirements for active military service, including a medical screening examination and background security investigation prior to being unconditionally accepted into USU. Detailed information is available at https://www.usuhs.edu.

Each of the four uniformed services is represented at USU – Army, Navy, Air Force, and Public Health Service (PHS). While attending USU, Navy students are commissioned on active duty as an Ensign and receive military pay for that rank. All tuition, fees, medical supplies, and books are provided.

In addition to meeting all the requirements for medical education, a USU student is exposed to both life in the military and military medicine. Classes are given in military medical history, chemical and biological warfare, wound ballistics, deployment medicine, as well as many other military topics. At least two field exercises are conducted over the 4-year curriculum, giving the student a concentrated and intense introduction to medical support during simulated combat operations.

Following graduation, the new Navy physician is obligated to serve in the Navy for seven years in a non-training status following completion of the PGY1 (internship) year. Any commitment previously incurred through either the Reserve Officer Training Corps (ROTC) or any of the military academies is added to this obligated service and served consecutively.

Health Professions Scholarship Program (HPSP)

As a recipient of a HPSP scholarship, the military pays full tuition, all fees, reimbursement for required books and equipment, and a stipend of approximately $2300 per month. Participants get 45 days of active duty for training each year and are paid full entry-level officer pay and allowances during that time. At the present time, a signing bonus of $20,000 is offered. Time in the program does not count for retirement or pay purposes.

In exchange for financing the participant’s medical school education, an obligation to serve on active duty for the number of years of scholarship benefit or a minimum of three years (whichever is greater) is generated. HPSP eligibility requires that the applicant be a U.S. citizen (dual citizenship is not permitted), physically qualified for a commission in the military, and accepted into an accredited school in the U.S. or Puerto Rico. The minimum undergraduate GPA required is 3.2 and the minimum MCAT score is 500. Applicants must not have reached the age of 42 at the time of commissioning on active duty. Here is a link to the Navy HPSP website.

Periods in which officers are in a training status (such as internship, residency, or fellowship) do not count towards fulfillment of the military contract but count towards military retirement.

Health Services Collegiate Program (HSCP)

HSCP is very similar to HPSP, but with a different benefits package. Rather than commissioning into the Inactive Ready Reserve (IRR), students receive pay and benefits (including health insurance, basic allowance for housing, etc.). Medical school tuition is not reimbursed, however the time spent in HSCP does count towards the 20-year requirement for retirement eligibility. This pathway is most often used by prior enlisted students with families who attend a relatively inexpensive medical school, although having previously served is not a program requirement.

Financial Assistance Program (FAP)

FAP is similar in concept to HPSP, with the exception that it applies to residency. Individuals can apply once they have been accepted to an accredited US residency program. The only caveat is that the types of residencies for which scholarships are offered may vary. Not all residencies and specialties will have a recruiting goal, so it is possible that the Navy does not offer the FAP scholarship to applicants in certain specialties.

Officer Preparedness Training

All medical officers attend 4 to 6 weeks of “Officer Development School” (ODS) located in Newport, Rhode Island. For USU students, this occurs prior to the first year of medical school. For HPSP students, this can occur at any time prior to graduation or immediately upon graduation. These courses are designed to give the new medical officer an orientation to military life as well as military customs and courtesies.

Graduate Medical Education

The typical pathways to residency training in the military are inservice programs at military treatment facilities (MTFs) or deferment and outservice programs that are completed at civilian residency training programs. For any given specialty, a graduate medical selection board is convened either in late November or early December to determine the program selection and the number of years of training for every applicant. Selection board results are normally published in mid-December.

Inservice Residency Training Programs at Military Treatment Facilities

Various Army, Navy, and Air Force MTFs around the country sponsor inservice residency training programs. They are all fully accredited by the Accreditation Council for Graduate Medical Education (ACGME). While in a dedicated post-graduate training program (internship, residency, or fellowship), payback towards the initial service obligation is on “hold.” The service commitment resumes upon graduation from training. Inservice training counts toward retirement, but generally incurs additional obligated service time that may be served concurrently with medical school and undergraduate educational obligations.

Navy Active Duty Delay for Specialist (NADDS) Programs for Residency Training Programs in Civilian Institutions

Some graduating medical students are selected for deferment for their entire residency, called the Navy Active Duty Delay for Specialist (NADDS) program. This means that the student can match as a civilian intern/resident and complete his/her training in a civilian program. Upon such completion, he/she then enters or returns to military service as a civilian residency-trained physician. In some cases, a similar deferment of service obligation is permitted for Medical Corps officers who are already in the process of completing or have completed an internship, called Release from Active Duty to NADDS or “RAD to NADDS.”

Other graduating students are, however, granted only a one-year deferment to complete an internship in a civilian program. They are then expected to serve in general medical practice as General Medical Officers (GMOs), Flight Surgeons, or Undersea/Diving Medical Officers (UMOs/DMOs) for 1-3 years before applying for further in-service, out-service, or deferred training. Once completing this tour, they can apply for residency training through the military or finish their military obligation in this role and separate from the Navy.

Application to this program follows the normal civilian “match” guidelines after approval from the Navy. Using the NADDS route to post-graduate training incurs no further obligation but it does not count toward payback for the initial obligation. USU students are now eligible for deferment training programs.

Full-Time Outservice (FTOS) Programs for Residency Training at Civilian Programs

Full-time outservice (FTOS) training allows Medical Corps officers already on active duty the opportunity to train at a civilian institution while remaining on full-time active duty status. Unlike members in a deferment program, FTOS trainees continue to draw their military pay. In addition, like inservice training, time served in FTOS training counts toward retirement.

The number of FTOS training slots awarded each year varies depending on the particular need for residency or fellowship trained specialists. Graduating medical students are generally not eligible for FTOS training.

Summary of Graduate Medical Education Options

As detailed above, there are many different options available for GME. The following chart summarizes the programs available to the different programs:

Unique Opportunities in Military Medicine

The military offers unique opportunities not normally available in civilian medical practice and training. There is the opportunity to practice medicine in a variety of geographic locations spanning the globe. Military physicians can readily take part in both combat and humanitarian medical missions. In addition, the military offers unique training for physicians in undersea/hyperbaric, flight, tactical and wilderness medicine and other non-traditional fields. The practice environment is vastly different from civilian medicine, with near universal healthcare coverage of the patients you treat as well as significant protections of the individual physician from malpractice and litigation. Finally, there is a significant financial benefit and security to be gained from a military retirement pension with an automatic annual cost-of-living adjustment.