Should I Keep Up My Clinical Hours?

Session 194

This premed has put her application on hold, and she wants to know if she should still be keeping up clinical hours into the next cycle.

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[00:26] Question of the Day

“I’ve seen your YouTube videos on the military HPSP scholarship. I’m applying this cycle. And I’ve actually gotten a little ahead of the game. And I’m already talking with the recruiter about going through the whole process. I actually have my physical scheduled for pretty soon before I’ve even gotten accepted to a med school. Obviously, you can’t use the scholarship without that.

But I wanted to talk to you a little bit about your experience with the scholarship, how it impacted you while you were a student, and a little bit of what you thought as a doctor coming out of med school, the differences that you felt between being a civilian versus being a military physician.”

[01:19] About the HPSP

The HPSP or the Health Professions Scholarship Program is done by the Army, Navy, and Air Force. Also, the VA now has an HPSP scholarship. I applied for and received the Air Force HPSP scholarship, which allows you to go to any fully accredited medical school here in the States, MD or DO. They’ll pay for your tuition and give you a monthly stipend. Some of the programs have some bonuses up front and give you some cash in the bank.

At the end of the day, my journey as a medical student was basically no different than anyone else. On campus, you don’t have to wear military clothes, you’re not on orders. You’re technically a civilian, just doing your thing. The Air Force, in my case, was paying for medical school. I was getting a monthly stipend put into my bank account, which was nice.

[02:22] Military Physician vs. Civilian Physician

From a day to day medical school experience, my experience was no different than my wife, who was also a medical student with me, and not on HPSP scholarship. I did the commissioned officers training before medical school.

So for a few weeks, I was down in Alabama. I was hanging out with my military clothes on and learning how to be an Air Force officer. This was before medical school, and so that didn’t affect me as a student.

[03:00] During the First and Second Years

Historically, they’ve tried to do something in between first and second year. For a lot of medical schools, this is your last summer as a student before going full bore into being a medical student, and then later on as a resident.

And so, depending on your school, if you have that summer, the military will probably expect you to spend some time with them. You will be on orders, and you will go wherever they want you to go to do some more training.

If your school doesn’t have that traditional summer, obviously, they’re awarding you a scholarship to get your medical degree. And so, they’re not going to do anything to jeopardize your standing as a student. They’re not going to force you to do anything that’s going to interrupt your schooling.

There are also students who get the scholarship too late that they won’t be able to do commissioned officer training before school. If that happens to you, you’re not doing anything with the military except having your school paid for. And that’s until after school when you need to do all of your officer training and stuff like that.

[04:36] Elective Rotation

Sometimes, you’ll be required some sort of elective rotation at a military hospital with whatever you’re potentially interested in. In my case, I did an orthopedic residency or an orthopedic rotation at the residency program for the Air Force in San Antonio when I was in school.

[05:00] Differences in Residency Applications

Q: “One question that has worried me a little bit is if you are going into a normal residency, which is virtually the entire school, and you have a question about how do I prepare myself to be competitive for orthopedics or what I need to be doing for OB GYN. You can go to the counselors, and they will have a plethora of advice because that’s their entire job. Did you feel like you had difficulty getting advice relative to the military-specific residencies you’re applying to?”

A: Residency applications are exactly the same. It’s a different match process because you’re applying to military residencies and you’re applying to civilian residencies since you apply to both. But at the end of the day, what they’re looking at is exactly the same.

Are you a good student? Did you pass your Step 1? Do you have a good Step 2 score? What kind of research do you have? For the military, there are a couple of extra things if you have prior active duty service, which most HPSP students aren’t going to have.

'There are a couple different things on a military rubric. But for the most part, it's exactly the same.'Click To Tweet

The advice that you’re going to use is exactly the same, and just the nuts and bolts of the match process is going to be a little bit different.

For instance, when you apply to the military match, you get the results, typically mid-December. That informs your ability to continue in the civilian match. Or the military says they want you for orthopedics, and you’re going to do it at their military hospital. Therefore, you don’t need to go to the civilian match.

[08:16] The Competitiveness in Matching

Matching in the Civilian World

Matching is competitive everywhere. If you aren’t on HPSP scholarship, you don’t have to apply to a military residency first. The opportunity is you can apply to every program out there, which is what most students are doing these days. Unfortunately, they’re just applying everywhere.

It increases your odds just for that reason but there are also more students applying for all of those spots.

Matching in the Military World

At that time, there was one orthopedic residency program in the Air Force. That was a limitation. But there was also a limitation on the number of students applying for that program as well. These were applicants from HPSP, the Uniformed Services University, and active duty flight surgeons who went back because they wanted to do orthopedics. Hence, the number of applicants is less, but the spots are very few and far between.

And so, if I wasn’t in the military, and I applied civilian, I could apply to lots of programs, but there are also lots more students applying to those programs as well.

The biggest difference is, if I was a civilian and I wouldn’t match in orthopedics, I could then make a decision with what I wanted to do with my life. I could still go to the program that I really wanted to go to. Maybe do research first as a graduate student or whatever, and then network and build connections and then reapply for the match the next time.

Whereas in the Air Force, I was their property. I didn’t get my orthopedic spot. I reapplied and didn’t get my orthopedic spot. And so, they assigned me to be a flight doc, so they already had a plan for me because I was their property. And they need physicians, even general medical officers who only have an internship under their belt.

Again, if I wasn’t in the military, I could have done whatever I wanted to make myself successful moving forward only with the specialty that I wanted.

[11:51] Choosing Which School to Go To

Going to USUHS vs. Civilian Medical School

Decide, first and foremost, where you’re going to be the most successful student. So if it’s a civilian medical school and not USUHS, then go to the civilian medical school and do the HPSP scholarship.

Going to the USUHS, which is the military medical school, gives you a couple different options. And it also handcuffs you a little bit as well, because you owe more time going to USUHS. You get paid to be a medical student above and beyond what you would have gotten as a stipend through HPSP. From a networking standpoint, this opens you up to build better connections with people who are going to make decisions for residency options. But that means you also owe the school seven years instead of four.

Going for the Prestige of Schools

There is always going to be the hierarchy of prestigious institutions and they want all of their students to come from prestigious institutions. But you will also find residents at those prestigious institutions who come from Podunk State University.

“Too many students go for the name and don't think about the fit.”Click To Tweet

There’s no guarantee that going to a competitive medical school was going to land you in one of those residency spots. What happens is you don’t perform as well, because you’re miserable. You’re burnt out and you’re not happy and you’re depressed. So you don’t do as well in your preclinical years and your clinical years. It rubs off on how you show up on your clinical rotations, your letters of rec, and your evaluations. And your clinicals aren’t as good as they could have been if you went to the school where you would have been a good fit, but it didn’t have the name.

At the end of the day, if you want to do HPSP and if you want to be in the military, then who cares where you go to medical school, and whether or not doing HPSP is weird or not? Go to the best medical school that you think is best for you. Do HPSP if you want to be in the military, go do the residency that is going to best serve your needs. And just keep going.