MD (USUHS) vs DO school (DMUCOM) with HPSP?

[Basicblub]

Most ppl say to choose:
MD > DO
HPSP > USUHS (if I don't plan to make military medicine my entire career)

[TLDR] So... do I choose USUHS (MD) or DMUCOM (DO) with HPSP?

Some Context:

• I was Army ROTC in undergrad (but got disenrolled by third year due to medical stuff but im cleared now for HPSP and USUHS) and now planning on staying Army
• I am definitely doing HPSP or USUHS. I think it would be great to see what mil med is like. I don't think I'd want to stay in the military as a career though
• I am interested in Ortho, maybe Peds? General Surgery? Obgyn? Plastics? Psychiatry? PM&R? ENT? (tbh i don't really know and ik it will change) Not rly interested in IM/FM rn but who knows, med school could change my mind

Some thoughts/concerns:

• Main concern: USUHS has a 7 year payback, and I hear that USUHS students aren't typically excited about the 3 extra years (compared to the 4 year payback from HPSP) if they're trying to get out
  • Note: I'm not trying to get out because of disliking the military or anything (as of now). I just want to be able to settle down and raise my future kids outside of the military and bases and constant moving.
• Fiancé is an M1 in Boston doing Army HPSP. USUHS location is closer and would allow us to visit each other more often. However, I know USUHS has 250mi radius limit or I have to use my leave days which people say is annoying.
• USUHS is a great MD school and will give me more opportunities compared to DMUCOM (also no need to take both COMLEX and USMLE, more mil rotations - better chance to be at the same hospital as fiancé for residency?), it just has added mil classes/trainings on top of med school.
• USUHS students make a lot more money than HPSP (which would be great for future plans like wedding/home/kids as well as traveling to visit fiancé/flying fiancé out)

pls help would love to hear your thoughts! thanks in advance!

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[swimwreck]

I'm just a first year HPSP at a DO school, but I believe you don't need to take both step and comlex. Army will only pay for one test, and the Army PDs I've heard from, don't care if you only take comlex. This is a really tough decision and idk what I would do in the situation.

 

[DrMetal]

• I am interested in Ortho, maybe Peds? General Surgery? Obgyn? Plastics? Psychiatry? PM&R? ENT? (tbh i don't really know and ik it will change) Not rly interested in IM/FM rn but who knows, med school could change my mind

If you want to stay competitive for said specialties, in both the civilian and military match, go to the allopathic school (USUHS).

As far as the difference in payback (4 vs 7), I guess it's a little significant. The delta there is 3 years (usually = one tour). If your goal was to pay back your time ASAP and GTFO, then go with HPSP (this is indeed the advantage of HPSP, that you can pay it back quickly and get out, as is done by many Navy GMOs).

If you anticipate being in the mil > 10 years (post med school) the delta is less significant. So go to the allopathic school.

 

[DOswag]

Personally I'm a DO so maybe a little biased. Also I was sooooooooo ready to be out of the military by my 4 year payback that to me it's not even a question I'd do HPSP and DO school. I don't know how much things have changed in the MD vs DO world but I never really felt it was even a thing back when I was in med school and I graduated in 2014. But it was still talked about a lot on here in the pre med and med forums as if there was a huge difference. Maybe if you were interested in an ivy league or prestigious program and going neurosurgery then yes. We had 2 or 3 in my small class of 70ish that I graduated with match into DO ortho programs and are doing quite fine now. I completed an MD residency in psych that accepted a handful of DO's every year and that was 2015-2019. Had plenty match in our class match ER programs, Anesthesia, several of us in Psych, of course lots of family med and IM, gen surgery, a few OBGYN's, one or 2 in ENT I think, can't remember if we had anyone match rads or derm but I don't recall if we had anyone specifically interested in those as well. I went to OSU-COM in Tulsa OK and we had pretty small classes back then too. Several of my classmates went to MD residency programs but many of the DO programs at that time were solid programs too. I know it's all merged now or something like that and I haven't really kept up with that. I currently work at an outpatient psych practice on the civ side. No job I applied or interviewed for asked me about my degree accept just in filling out paperwork to prove I was a DO all of them were accepting both MD's and DO's. I get paid equal to my MD counterparts, rarely do patient's ask about and that's just if they happen to notice on my scrubs it says my name then DO.

 

[CCM-MD]

Go MD. It will give you the best shot at some of the highly competitive specialties you listed (Ortho, Plastics, ENT).

 

[Basicblub]

Personally I'm a DO so maybe a little biased. Also I was sooooooooo ready to be out of the military by my 4 year payback that to me it's not even a question I'd do HPSP and DO school. I completed an MD residency in psych

Did you do a civilian residency and then serve the 4 years? The residency doesn't count towards payback but doesn't add years either right?

 

[DOswag]

Did you do a civilian residency and then serve the 4 years? The residency doesn't count towards payback but doesn't add years either right?

The residency I did was a combined mil/civ residency. There were a good number of us that were mil residents but everyone did rotations at the mil and the civ sites. We were active duty during residency but not in a deployable status. We got paid a decent bit more than the civ residents. The wording is always confusing in how it's explained but essentially either way you go civ or mil residency (well for psych anyway) it wouldn't change the number of years you owe. If your training ends up being longer than your payback, which can be the case for other specialties, that can add years onto your service obligation after residency. I did my 4 years of payback after residency and got out last summer. Sweet civilian freedom now!

 

[Konigstiger]

My vote would be for USUHS. I'm assuming that either way, you will want to do residency in the military, in which case the DO stigma is much less of a problem and you probably wouldn't even need to take STEP if you went to a DO school. However, if you do want to do a competitive residency like many of the ones you listed, then you will still be better off going to USUHS as you will have more opportunities to work with military doctors in those fields and you will have more opportunity to do research in those fields, both of which will put you at a significant advantage even in the military match when compared to a civilian DO student who simply will not have those opportunities. If you're thinking of doing residency in the civilian world and doing the bare minimum of military service, then honestly USUHS might still be the better option because an MD degree will always open more doors than a DO degree to civilian PDs regardless of your scores or the rest of your application.

Also, don't discount how god awful OMM is. It will suck several hours of your life away every week going to OMM lab/practicals and studying OMM for exams. This is a significant amount of time that an MD student would be using to either rest and recover or to study for their board exams, and you will be wasting it doing something you probably will never even use outside of medical school.

The only confounding factor in all of this is how much you will dislike being in military medicine. If you find yourself absolutely hating it, then I am sure those extra USUHS years will feel like torture and you will be wishing you went to the DO school. There is no way to know this in advance, though, so I would still say USUHS is the better option.

 

[DOswag]

My vote would be for USUHS. I'm assuming that either way, you will want to do residency in the military, in which case the DO stigma is much less of a problem and you probably wouldn't even need to take STEP if you went to a DO school. However, if you do want to do a competitive residency like many of the ones you listed, then you will still be better off going to USUHS as you will have more opportunities to work with military doctors in those fields and you will have more opportunity to do research in those fields, both of which will put you at a significant advantage even in the military match when compared to a civilian DO student who simply will not have those opportunities. If you're thinking of doing residency in the civilian world and doing the bare minimum of military service, then honestly USUHS might still be the better option because an MD degree will always open more doors than a DO degree to civilian PDs regardless of your scores or the rest of your application.

Also, don't discount how god awful OMM is. It will suck several hours of your life away every week going to OMM lab/practicals and studying OMM for exams. This is a significant amount of time that an MD student would be using to either rest and recover or to study for their board exams, and you will be wasting it doing something you probably will never even use outside of medical school.

The only confounding factor in all of this is how much you will dislike being in military medicine. If you find yourself absolutely hating it, then I am sure those extra USUHS years will feel like torture and you will be wishing you went to the DO school. There is no way to know this in advance, though, so I would still say USUHS is the better option.

I think the military time from USUHS is a big factor and having done my time after HPSP, would not choose USUHS just to get the MD instead of a DO. In my opinion that trumps the MD vs DO debate, but as I said before I’m a little biased as a DO and I knew I wasn’t going ortho/plastics/ENT/crazy competitive specialties. 7 years after residency is a long time if you know you’re not staying in. Counting residency you’ll probably be in the double digits of years by the time you get to the end of your obligation and will then have to weigh the options of staying til retirement vs separating at that time. Lots of year of missing out on civ practice pay which, if you’re in one of those specialties is to the tune of 7 figures.

I didn’t think OMM was god awful all the time lol. But yeah I don’t use it other than if a family member wants me to pop their neck or back. Cranial was a little voodoo-ish to me.

I get that MD may open some more doors than a DO. But I don’t think that would be as much of a positive as the extra years would be a negative. Pretty sure in the mil residencies it’s not near as big of a deal as like some ivy league programs. If you end up getting into one of those specialties as well, skill atrophy will be a real fight and you’ll likely have to work hard to keep skills up taking cases at a civ hospital on your own time because in the military after residency you’ll be taking care of a young healthy population.

 

[DrMetal]

I knew I wasn’t going ortho/plastics/ENT/crazy competitive specialties.
I get that MD may open some more doors than a DO. But I don’t think that would be as much of a positive as the extra years would be a negative.

I vehemently disagree. The more doors and advantages of being an MD are worth the extra 3 year commitment. 3 years is nothing (again, =1 tour), as compared to your remaining 30 years of practice. Why get pigeon-holed into a primary care specialty when you might have the opportunity to do something more sub-specialized? That opportunity is worth an extra 3 years of service. And those who take fellowships (even with near complete commitments) would agree with me.

I didn’t think OMM was god awful all the time lol. But yeah I don’t use it other than if a family member wants me to pop their neck or back. Cranial was a little voodoo-ish to me.

It's all voodoosih. That stuff is all BS, placebo at best. We know it.

 

[Barrel Proof]

I agree with DrMetal. Go to USUHS. Why potentially close doors now? MD gives you a leg up in competitive specialities. The DO bias still exists I’ve seen it first hand. If you go to USUHS, work hard and perform well you will have an excellent chance of matching in whatever speciality you choose.

 

[comp1]

I know there's a lot to compete, but Nixon's failure to convert all DO schools to MD is one of his greatest failures.

 

[DOswag]

I vehemently disagree. The more doors and advantages of being an MD are worth the extra 3 year commitment. 3 years is nothing (again, =1 tour), as compared to your remaining 30 years of practice. Why get pigeon-holed into a primary care specialty when you might have the opportunity to do something more sub-specialized? That opportunity is worth an extra 3 years of service. And those who take fellowships (even with near complete commitments) would agree with me.



It's all voodoosih. That stuff is all BS, placebo at best. We know it.

I don't disagree with yall as far as MD getting more opportunities. I guess I disagree as to what extent that may be though, as I don't believe the gulf is as wide as many believe it is. It's not like a DO is forced to go into primary care and has zero opportunities for anything else.

I think this is where I stand on the MD vs DO argument. Yes DO schools TEND to place more emphasis on primary care specialties and a higher percentage of us go into primary care. I was a very average student as far as class ranking and boards, literally smack in the middle of my class, right at average scores, only took COMLEX, got into a solid MD psych program in the military that's a split mil/civ program. Felt I was very well trained for psychiatry. I’m in a job in psychiatry that has the potential to earn upper 6 figures every year working 40 hours and a 4 day work week, no call, no nights, no weekends. I’m in my first year and I’m on pace to make just shy of 400K. Other DO’s that work for the same practice make 5-600K yearly, some a million a year. We’re by far not the only ones that do this. I interviewed for several jobs in multiple states when I separated from the service and I was never asked why I went to a DO school instead of an MD school. We aren’t all skimping for 200K jobs out there. I acknowledged that an MD can open doors for you that a DO can’t though. Yet plenty of my classmates at a school that had relatively small class sizes to other schools are in specialties such as ER, ortho, anesthesia, surgical specialties, ophtho, IM sub-specialties etc. I did a transitional rotating internship with several who went into Derm, Rads, PM&R etc. Yes the majority in my class went into primary care as is the case with most DO schools. I don’t necessarily think we’re pigeon holed as much as many believe though. From what I recall from my class in 2014, the ones who went into primary care went into it because they wanted to go into it, came into med school wanting to be a family doc or pediatrician. It wasn't because they couldn't match into something else. I'm sure it happened to someone but if it did, it wasn't very many of our number. But yes the bias still exist. It is more of an uphill battle if you want to go to certain programs and some competitive specialties. There's some out there that flat out will not take you as a DO. That doesn't mean you're completely excluded from specialties beyond primary care though. I think the military match equalizes that much more than the civ side. If you're a competitive applicant as a DO you can still get into a very competitive specialty. If you're an average DO applicant and play the mil game such as flight med for a few years, you can get a competitive specialty. If you GMO/FS and GTFO, you can still get a competitive specialty on the civ side. I could be completely wrong and misguided by my thinking as I'm going off of personal experience as being a DO and I'm not involved with the resident/academic world at all. But SDN is by far the most I've been looked down upon for my degree and as far as I know, it hasn't happened at all in the real world. Now again I wasn't trying to go ortho at an ivy league program either. Again, there's bias for sure. But there are plenty of programs with good training in very competitive specialties that are very friendly to DO's. There are DO programs (well used to be DO exclusive) in those specialties as well.

Won't argue too much about OMM since I'm not using it. I do think there's some practical uses for some of it but by and large don't really care for a lot of it. It didn't take up a lot of extra time but it was something additional that we had to prepare for, test over in school and on board exams.

 

[DOswag]

Also go check out the DO med student forum. Have a thread of match lists from various schools. Yes still majority go family or IM but plenty of anesthesia, ER, Ortho, ENT, Rads, Derm, Ophtho, surgical, PM&R, Psych etc represented in there as well.

 

[CCM-MD]

Also go check out the DO med student forum. Have a thread of match lists from various schools. Yes still majority go family or IM but plenty of anesthesia, ER, Ortho, ENT, Rads, Derm, Ophtho, surgical, PM&R, Psych etc represented in there as well.

No question it can be done. It’s just much harder, and the odds of success are worse. I’d much rather play the game on normal mode than hard mode. It’s hard enough on normal mode if you want one of those highly desired specialties.

 

[Basicblub]

A late afterthought I didn't consider but - I'm curious what y'alls thoughts are on possibly just doing the DO school without HPSP?

Would the MD still trump the DO here? Even if it's USU?

It's also because I hear a lot of people say not to do military straight up if possible and just take the loans

 

[DrMetal]

A late afterthought I didn't consider but - I'm curious what y'alls thoughts are on possibly just doing the DO school without HPSP?

Would the MD still trump the DO here? Even if it's USU?

It's also because I hear a lot of people say not to do military straight up if possible and just take the loans

That's a very different question. The delta between 4-yr HPSP commitment vs 7-yr USU can be small and somewhat even trivial.

The delta between 0-yr commitment (ie no military service at al) vs. 7-yr USU commitment is MUCH more significant. In this case, and especially if you're having second thoughts about joining the mil, I would argue it's not worth the MD from USU.

Of course you can take loans and do it yourself.

 

[pgg]

The delta between 4-yr HPSP commitment vs 7-yr USU can be small and somewhat even trivial.

This maybe bears further explanation for pre-meds who aren't familiar with how the service obligations work, when residency and/or GMO time is factored in.

There are COMMON scenarios in which the total obligated service for HPSP and USUHS can work out to being the same.

One example

HPSP grad - owes 4 years - internship (owes 4) - 3 year GMO tour (owes 1) - 4 year residency (owes 4)
USUHS grad - owes 7 years - internship (owes 7) - 3 year GMO tour (owes 4) - 4 year residency (owes 4)

 

[afteranesthesia]

I would take the DO and no HPSP, and I was an MD and did HPSP plus extra years for fellowship. The military doesn't care about you. You are literally a warm body on a list, and they won't even care if they sanction a fellowship. You will spend all your time trying to maintain your skills. If you care about that at all.

 

[Basicblub]

I would take the DO and no loans, and I was an MD and did HPSP plus extra years for fellowship. The military doesn't care about you. You are literally a warm body on a list, and they won't even care if they sanction a fellowship. You will spend all your time trying to maintain your skills. If you care about that at all.

take the DO and no loans? so do HPSP? or did you mean take the DO and loans? (just the way you talked about the military got me confused lol)

 

[afteranesthesia]

take the DO and no loans? so do HPSP? or did you mean take the DO and loans? (just the way you talked about the military got me confused lol)

The military sucks so bad. Take loans. Do whatever nonmilitary option you have. I hated my military time. HATED.

 

[DrMetal]

The military sucks so bad. Take loans. Do whatever nonmilitary option you have. I hated my military time. HATED.

Sounds like you're very entitled and weren't cut out for it in the first place.

Of course the military doesn't care about you specifically, it's not supposed to. Get over it. The military is warfighting unit, much bigger than you. You have to understand that going into it. You have to curb your expectations. If you can't do that, permission granted to pursue civilian life.

 

[pgg]

Sounds like you're very entitled and weren't cut out for it in the first place.

Of course the military doesn't care about you specifically, it's not supposed to. Get over it. The military is warfighting unit, much bigger than you. You have to understand that going into it. You have to curb your expectations. If you can't do that, permission granted to pursue civilian life.

Well, I don't know his story, or why he was so unhappy in the military.

But I could write pages and pages and pages of compelling arguments and personal anecdotes about how most of the disappointing aspects of physician practice in the military are absolutely NOT reasonable or expected concessions to the larger mission of killing people and breaking things in faraway places.

I'd go so far as to say that, by far, the most rewarding and least dysfunctional periods of my 20 year career were when I was deployed and working for the warfighters. There is no "warfighting" reason that practice at a CONUS MTF has to be the low volume, low acuity, non-clinical-nonsense burdened absurdity that it has become in the last few decades. Indeed, this state of affairs is objectively harmful to that mission.

 

[DrMetal]

Well, I don't know his story, or why he was so unhappy in the military.

But I could write pages and pages and pages of compelling arguments and personal anecdotes about how most of the disappointing aspects of physician practice in the military are absolutely NOT reasonable or expected concessions to the larger mission of killing people and breaking things in faraway places.

I'd go so far as to say that, by far, the most rewarding and least dysfunctional periods of my 20 year career were when I was deployed and working for the warfighters. There is no "warfighting" reason that practice at a CONUS MTF has to be the low volume, low acuity, non-clinical-nonsense burdened absurdity that it has become in the last few decades. Indeed, this state of affairs is objectively harmful to that mission.

All true. But most of this is us, the MC, crapping on itself. It's not the line military devising ways to make physicians unhappy.

Look I'd advocate for shutting down most of the MTFs and turning most of the MC into a reserve force.

 

[afteranesthesia]

Sounds like you're very entitled and weren't cut out for it in the first place.

Of course the military doesn't care about you specifically, it's not supposed to. Get over it. The military is warfighting unit, much bigger than you. You have to understand that going into it. You have to curb your expectations. If you can't do that, permission granted to pursue civilian life.

You are right. It's that simple. You figured me out. I should have wanted to love the military more than my ability to be an attending with credentiable skills once out. Silly me. In all seriousness, why are people not allowed according to you to do the military and end up hating it? Doesn't mean I am entitled. Means I had a very negative experience. You don't know the details. You don't know why. It doesn't mean I am entitled or not cut out for it. Means that I hated it. Which I am allowed to do. My expectations were curbed, and I hated it still. And thanks for the permission to pursue civilian life. I did the second my obligation was up.

 

[afteranesthesia]

All true. But most of this is us, the MC, crapping on itself. It's not the line military devising ways to make physicians unhappy.

Look I'd advocate for shutting down most of the MTFs and turning most of the MC into a reserve force.

It will never happen, but I agree with you here. This should 100 percent occur.

 

[Mace1370]

Go to USUHS. Keeping doors open is absolutely worth an extra 3 years. As pgg pointed out, HPSP can even end up giving you a bonus +3 if you get pushed into a GMO tour. You will have a long career after your time in the military is over and you don't want to negatively impact it.

 

[MedicalCorpse]

You are right. It's that simple. You figured me out. I should have wanted to love the military more than my ability to be an attending with credentiable skills once out. Silly me. In all seriousness, why are people not allowed according to you to do the military and end up hating it? Doesn't mean I am entitled. Means I had a very negative experience. You don't know the details. You don't know why. It doesn't mean I am entitled or not cut out for it. Means that I hated it. Which I am allowed to do. My expectations were curbed, and I hated it still. And thanks for the permission to pursue civilian life. I did the second my obligation was up.

I hear you, brother.

Look up my posting history, especially between 2006-2008, and you will see that you are not alone.

My best synopsis is still this post and the thread that follows:

35 Reasons Not to Join Military Medicine​

All Branch Topic (ABT) - 35 Reasons Not to Join Military Medicine

And, yes, I punched out after paying back 4 years for ROTC and 7 years for USU and walked away with nothing...
except mental scars I will take to my grave.

By the way, I had to take down Medicalcorpse.com during my divorce so it wasn't used against me. I don't have the motivation to put it back up and hear all the whining from some people that I need to sit down, shut up, and just take orders like a good soldier/sailor/airman/guardian/whatever, no matter how that passivity in the U.S. military medical corpse (sic) has led to and is still causing actual patient deaths due to malpractice by incompetent "providers" who think they know as much as physicians because they binge watch old reruns of "House".

You are not alone in having been traumatized during what was supposed to be a career, but which ended up being a nightmare.

 

[MedicalCorpse]

There is no "warfighting" reason that practice at a CONUS MTF has to be the low volume, low acuity, non-clinical-nonsense burdened absurdity that it has become in the last few decades. Indeed, this state of affairs is objectively harmful to that mission.

There is only one thing worse than being stuck at a low volume, low-acuity MTF with no way to quit and run away...

...and that is being stuck at a terminally-downsized, understaffed, underfunded pseudo-hospital surrounded by idiot surgeons who want to play once in a blue moon by doing sexy, low-volume, HIGH-ACUITY, super-dangerous procedures like AAAs, CEAs, aorto-bifems, anterior mediastinal mass resections, etc., at a facility which is woefully unprepared as an entire system to manage these cases safely. When your RNs are O-1s, your techs are undertrained, your ICUs run by interns overseen by trembling FPs forced to take over for the one intensivist who is deployed, your CRNAs and yourself are rusty in everything having to do with getting a patient through these procedures from double-lumen tubes to central lines and beyond, AND your surgeon is a psychopathic, incompetent maroon who may have been trained at an ivory tower civilian fellowship, but who has a nearly 100% take-back rate for every carotid for bleeding, you will know you are in a new circle of Hell that Dante never imagined: U.S. MTFs after circa 2000.

This problem of the military staffing dead MTFs with cowboy vascular-thoracic surgeons needs to be fixed, before even more active duty troops, retirees, and dependents die.

By the way, I would concur with transferring military medicine to the reserves, but a friend of mine is a reserve O-6 in the Air Force, and the word is not good. I can't be too specific to protect them and national security, but I don't have any confidence that the current military reserve system is any more competent than what is left of military medicine now that DHA has taken over.