As a graduating medical student on a military scholarship, I get a lot of questions…
Understanding Civilian Sponsored Residency
I have gotten a few questions recently about civilian sponsored residency, so today I would like to take a few minutes to explain what civilian sponsored residency means.
For those who aren’t familiar with how the military match works, please check out this post for some more information.
Essentially, if you participate in the military match, you can be assigned to one of three kinds of residency spots: a spot in a military residency program, a civilian deferral (more on that here and here), or civilian sponsorship.
Reviewing the options
We’ll start by reviewing the basics of the three types of residency (active duty, civilian deferred, civilian sponsored). If this is old news, feel free to skip ahead.
If you are assigned to train in a military residency program, you will find out on military match day the location and specialty to which you have matched. You will be on active duty during your training, with full pay and benefits. You also accrue years of service towards promotion and retirement. You do not owe any additional active duty time for training in this time of residency. For example, if you received a 4-year HPSP scholarship and completed a 3-year military internal medicine program, you would owe 4 years on active duty after residency.
If you match to civilian deferral in the military match, that means that the military has assigned you to participate in the civilian residency match, and to complete your residency in a civilian program. You will be placed in an inactive reserve status during your residency. You have no military obligations and receive no military pay or benefits – you are treated the same as any other resident in your civilian program. Because you are not on active duty, you do not accrue years of service towards promotion or retirement. For example, if you received a 4-year HPSP scholarship and completed a 3-year civilian deferred internal medicine program, you would owe 4 years on active duty after residency.
If you match to a civilian sponsorship in the military match, the military has assigned you participate in the civilian match and complete a civilian residency. The difference between sponsorship and deferral is that when you are sponsored by the military, you are on active duty and receive full military pay and benefits. Your civilian residency program can’t pay you or give you any benefits. Even though you are on active duty, you are assigned to participate full-time in your civilian residency program. You have no military commitments while you are in training. You accrue years of service towards promotion and retirement. But, you also owe one additional year of active duty service for each year of civilian sponsored training. So if you received a 4-year HPSP scholarship and completed a 3-year civilian sponsored internal medicine program, you would owe 7 years on active duty after residency (4 years for medical school and 3 years for residency).
What’s the advantage?
The advantage to a civilian sponsored residency is that you make a lot more money. Military pay and benefits comes to about $70k/year for a first-year resident (possibly more depending on the location), compared to about $50k/year for someone doing the same work in a civilian deferred position. Over a four-year OB/GYN residency, a civilian sponsored resident will make $75-100k more than a civilian deferred resident in the exact same program. The sponsored resident will also have four extra years of time in service for pay purposes at graduation, so the pay gap continues even after graduation through the entire active duty payback period.
What’s the down side?
The down side is the additional service commitment – an additional year of payback time on active duty for each year of training. In many specialties, you will make a lot less money in the military than you would as a civilian in the same job, so the finances don’t always work out. Pay aside, more time on active duty also means more years before you can choose where you want to work. It means more years of deployments, TDYs, and all of the other extras that go with being on active duty.
Is civilian sponsored training the best choice for you?
Civilian sponsored training can be a good choice for people who need to make more money early on (like people with a family or with lots of school loans from other degrees). People who already owe the military a lot of active duty time might also benefit from civilian sponsored training – if you already owe 5 years for attending a service academy, for example, and you are planning to make the military a career, then the extra service commitment may not be a deterrent, and the extra money might be a nice bonus.
What about fellowship?
The Air Force tends to only offer fellowship training in a civilian sponsored status, so sponsored might be your only choice here.
Can I match to civilian sponsored training if I don’t rank it?
Yes, the military can assign you to civilian sponsored or civilian deferred training in your specialty of choice, whether or not you rank civilian training on your rank list.
The bottom line
Civilian sponsored training, like anything else in military medicine, can be great for people in the right situation. The key is to understand what you are agreeing to: more money, less career flexibility, more time on active duty.
What other questions do you have?
I’m planning on applying for the Air Force HPSP. I have plans on applying to either dermatology or emergency medicine. My main goal is dermatology. I was wondering what are the chances of receiving a civilian deferral or a civilian sponsored since there are so little derm spots in Air Force. Lets assume I have top 10 percent scores on step 1/2, good clinicals, EC etc.
The way the military match works, you match into a specialty first, and then military or civilian. So for example, in 2018 the Air Force only needs one dermatologist, so they are only offering one dermatology spot in the military match. This spot is in San Antonio. Civilian training is not being offered this year. They offer civilian training only if they need to train more people in a particular specialty than the military programs can accommodate. So, for example, if they need three dermatologists next year and only have one military spot, they might send two out to do civilian training. If they have three people applying for that one spot, one will get the spot and the other two will match into a backup specialty or go unmatched, which in the military means doing an internship only and then spending 2-3 years as a GMO (primary care) before reapplying. Because of the small numbers involved, you never know what the match rate is going to be in a given specialty any given year. For example, one year they might only have one person apply to derm, another year there might be five for the same single spot, and there is no way to predict which it will be. Emergency medicine is a little bit bigger pond (35 positions in 2018, including 5 civilian deferred and 8 civilian sponsored) so your odds are probably better. If you think you really do want to go into derm, HPSP is probably not a great option for you.