Scholarships-for-Service: Financial Outcomes of Military and Government Scholarships for Medical Students.

Abstract

Introduction: The cost of medical education has risen significantly, leading many prospective physicians to seek financial assistance through military and government scholarship programs. These programs, including the Health Professions Scholarship Program (HPSP), Uniformed Services University of the Health Sciences, Medical and Dental Student Stipend Program (MDSSP), and Department of Veterans Affairs (VA) HPSP, offer tuition coverage, stipends, and financial incentives in exchange for service commitments. Although these pathways provide the potential for debt-free education and early-career compensation, concerns remain about their long-term financial trade-offs compared to civilian medical practice. Previous studies suggest that while military and government service physicians may experience lower initial salaries, pension benefits and retention incentives can offset financial disparities over time. However, current literature lacks a comprehensive analysis that accounts for key financial factors, including specialty-specific earnings, military bonuses, and federal pension structures. This study seeks to fill this gap by systematically comparing the lifetime financial outcomes of 6 physician career pathways across 3 medical specialties: orthopedic surgery, internal medicine, and anesthesiology.

Materials and methods: A financial model was constructed to track lifetime earnings from medical school entry at age 22 to retirement at age 65. Each pathway was analyzed based on 2 career trajectories: early leave, representing physicians who separate after completing their minimum service obligation, and late leave, representing those who complete a pension-eligible military or government career. Compensation calculations incorporate base salaries, stipends, residency pay, bonuses, retention incentives, and pensions. Location-dependent factors such as Basic Allowance for Housing and cost-of-living adjustments were integrated for accuracy. Civilian salaries were sourced from Eastern Virginia Medical School resident pay tables and Doximity's 2023 Physician Compensation Report, while military and VA compensation data were derived from government reports.

Results: Findings indicate that while military physicians generally earn lower salaries during service compared to their civilian counterparts, benefits such as debt-free education, stipends, and pension plans contribute to long-term financial competitiveness. The largest determinant of lifetime earnings was specialty selection rather than pathway choice. Orthopedic surgeons consistently earned the highest lifetime compensation across all pathways, while internal medicine physicians exhibited more comparable earnings between military and civilian careers. Notably, pathways incorporating VA service and reserve military duty, such as MDSSP and VA HPSP, demonstrated competitive lifetime earnings relative to civilian practice, particularly in lower-compensated specialties.

Conclusions: The financial outcomes of military and government service pathways for physicians are generally competitive with civilian practice, particularly when factoring in pension benefits and debt-free education. Specialty choice remains the primary driver of lifetime earnings, often outweighing differences between pathways. Beyond financial considerations, intangible benefits such as leadership opportunities, unique training experiences, and job security should also inform students' decisions when evaluating service-based medical education programs. Understanding these financial trade-offs is critical for students making informed career decisions, as well as for policymakers assessing the effectiveness of recruitment and retention incentives.