A few weeks ago I wrote about the pain and confusion of attempting to cover the cost of education through student loans. There is, of course, an easy answer to avoiding all of this nonsense, so I want to talk a bit about why I chose not to go into the military or apply for the National Service Health Corps.

If it weren’t for the military scholarship, I would likely not be starting medical school in a few months. The seed that was planted in my mind three years ago (by a bygone acquaintance), was that I would apply to the Uniformed Services University of Health Sciences (USUHS) in Bethesda, Maryland. Anyone who promises time to the military after medical school (three to seven years depending on your situation) gets their tuition paid for outright, a small stipend to live on while in school, and a $20,000 signing bonus. (In addition, it was one of the few schools that might have accepted a slew of community college credits as prerequisites. Before I knew I was doing an official postbac, or even what a post-baccalaureate pre-medical program was, this was an important piece.)

Let me tell you, even I know it’s tempting.

The thing about the military is that you can attend medical school anywhere you want to, but afterward your options become extremely limited. The military needs certain kinds of doctors and they need them in specific places.

Everyone who finishes medical school will eventually match into a residency program. This is done by a computer: you list your top programs, the program lists its favorite applicant, and the computer figures out the lowest common denominator. The military has the same approach to residency, but it’s separate from the civilian match program. This means residencies for specialties the military needs–general surgery, general medicine, trauma–are going to far outnumber the ones they have less demand for. Sure, even the military needs pediatricians and plastic surgeons, but those positions are much more competitive. (I looked up neurology and, in my brief research, it looked like there was only a single residency program in the country.)

Beyond the limitations in specialties, there is something about the military that I don’t think would fit me very well. First of all, I’m a wimp and the prospect of boot camp is enough to give me pause. More importantly I do not, as my mother says, suffer fools gladly. I’m not known for keeping my mouth shut when I disagree with someone. I’ve heard that doesn’t always go over well in the military hierarchy.

The other pay-your-way-through-med-school option is the National Health Service Corps. This is a program you apply for (they are very selective) and if you are accepted, they will pay your entire tuition up front. In exchange you agree to do your residency in general medicine (internal medicine, pediatrics, family medicine all count) and work for a number of years in an area that is low on physicians.

Even if you aren’t accepted outright, the program will reimburse you for some of your tuition if you end up working in one of these areas after residency. Many schools also have smaller versions of the program that will give you a break on tuition if you agree to practice in a rural area for some time.

Leaving aside the fact that my heart leans toward neurology as a specialty, there is a reason why the government would be willing to pay for an entire medical education to get you to live and work in one of these locations. It’s not a happening place to be. Many of them are extremely rural, and a number are located on Native American reservations way off the beaten path. Rural areas are rated by how hard up they are for medical care. For the full package, the required level is pretty high. There is only one qualified area in the state I’m living in now, and it’s a men’s prison.

For both the military and the National Health Service Corps, you sacrifice a certain level of freedom in exchange for not having to play the same debt game as the rest of us. The question, of course, is, “Is it worth it?”

If you already wanted to go into the military or if you were planning on rural primary care for your specialty, the answer is, “Definitely.”  But if you’re like me, and would never even consider these options except that the prospect of debt sends shivers up your spine, that question is a little harder to answer.

In the end I decided this: the choice to go to medical school was a choice to live out a dream. There are always practical limitations on our dreams, but there is also value in giving them room to expand and change. Right now I want to be a neurologist. That might change and I might decide that more than anything I want to go into a specialty that would be perfect for the military or the National Health Service Corps.

I spent a lot of time and effort doing things that were not quite on the path I eventually ended up on. I was blessed to have the means and support to change my goals and to not be forced to regret my initial choices. I don’t want to look back six years down the line and think, “I came justhisclose to my dream, but missed it because of money.” Money, even a whole bunch of it, isn’t worth the rest of your life.

That said, I think these programs are wonderful. If you are a prospective medical student considering either of these, please listen to many voices before making your choice. My best advice would be this: if you want the future these programs ask of you, go for it and never look back. But don’t do it just for the money. Do it because at the end of it all you’re going to have lived the life you want to live and the scholarship helped you get there.


PS. If you are prospective student looking into any of these programs, I highly recommend talking to people who have made the commitment and are a) still in school or b) well beyond it to see what they have to say. Also, both programs offer versions of their scholarships you can sign up for midway through medical school or after graduation. If you’re undecided, don’t feel rushed to choose before you start school. Better to have to pay off a bit of interest than to get locked into a commitment you regret. (The National Health Service Corps charges something like 100% interest on the money they shelled out for your education should you not follow through. Those guys don’t mess around.)