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Economic analysis of the military health professions scholarship program for neurosurgeons
Brian T Ragel1, Paul Klimo, Gerald A Grant
1Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA brian.ragel@gmail.com
Insights
The military Health Professions Scholarship Program (HPSP) offers a debt-free path to neurosurgery, though military neurosurgeons earn significantly less than their civilian counterparts over 14 years.
Area of Science:
- Neurosurgery
- Medical Economics
- Military Health Systems
Background:
- The Health Professions Scholarship Program (HPSP) is a 4-year military scholarship covering medical school costs.
- Participants incur a 4-year military service commitment, extendable for bonuses.
Purpose of the Study:
- To compare the long-term economic outcomes for neurosurgeons.
- Analyze the financial implications of the HPSP versus civilian practice.
Main Methods:
- Utilized data from AAMC, MGMA, and 2009 military pay tables.
- Constructed 14.25-year cash flow models (4 years medical school, 6 years residency, 4.25 years practice).
- Applied a present value economic analysis.
Main Results:
- Mean medical school debt was $154,607 for non-HPSP students.
- Mean annual salaries after 14.25 years: Military $160,318, Academic $451,068, Private Practice $721,458.
- Cumulative present value cash flow after 14.25 years: Military $1,193,323, Academic $2,372,582, Private Practice $3,639,276.
Conclusions:
- Significant financial disparities exist between military and civilian neurosurgery.
- Military neurosurgeons avoid substantial medical school debt, while non-military surgeons accrue approximately $208,000 in debt.
Background:
The 4-year military Health Professions Scholarship Program (HPSP) provides funds for medical school tuition, books, and a monthly stipend in exchange for a 4-year military commitment (to receive all physician bonuses, an additional 3 months must be served).
Objective:
To analyze the economics of the HPSP for students with an interest in neurosurgery by comparing medical school debt and salaries of military, academic, and private practice neurosurgeons.
Methods:
Salary and medical school debt values from the American Association of Medical Colleges, salary data from the Medical Group Management Association, and 2009 military pay tables were obtained. Annual cash flow diagrams were created to encompass 14.25 years that spanned 4 years (medical school), 6 years (neurosurgical residency), and the first 4.25 years of practice for military, academic, and private practice neurosurgeons. A present value economic model was applied.
Results:
Mean medical school loan debt was $154,607. Mean military (adjusted for tax-free portions), academic, and private practice salaries were $160,318, $451,068, and $721,458, respectively. After 14.25 years, the cumulative present value cash flow for military, academic, and private practice neurosurgeons was $1 193 323, $2 372 582, and $3 639 276, respectively. After 14.25 years, surgeons with medical student loans still owed $208 761.
Conclusion:
The difference in cumulative annual present value cash flow between military and academic and between military and private practice neurosurgeons was $1,179,259 and $2,445,953, respectively. The military neurosurgeon will have little to no medical school debt, whereas the calculated medical school debt of a nonmilitary surgeon was approximately $208,000.
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