Is now the time to consider the military?

The fight against terrorism has spurred many to personal action. Although there are plenty of benefits to joining the Reserves, there are frustrations, too. If you're interested, you need the full picture.

By Dennis Murray
Senior Editor

With the war on terrorism likely to continue for years, physicians are calling their local armed forces recruiting offices, asking what they can do to help. While joining up for the regular Army (or Navy, or Air Force) would certainly be an escape from today's private practice hassles, most doctors who want to serve their country will join a Reserve* unit. Here's what to expect from such a commitment.

As a physician, you'll enter the Reserves as a commissioned officer. And, unlike active-duty GIs, reservists get to live in their own homes. Your introduction to the armed forces will begin with two weeks of basic training, which will be followed by one weekend a month plus a two-week training period each year (typically held during the summer).

During this time, recruits will become familiar with military rules and protocols and participate in training exercises, such as learning how to deploy a field hospital. All medical reservists also get to attend military-sponsored CME, seminars, and conferences, which detail the latest techniques and technologies.

"I was surprised and pleased by some of the smaller perks, like free travel and discounted gasoline," says Robert M. Cosby, a family physician in Birmingham, AL, who served for 16 years in the Army National Guard. Now a colonel in the Army Reserves, Cosby adds that his military service fulfilled a dream that his father, an ex-Marine, had for his sons. "That was by far the most important benefit to me," he says.

Like Cosby, you'll also be required to put your medical skills to good use, by helping care for military families and retired service people during your monthly weekends and two-week training periods. You'll be paid for this work: roughly $1,000 a month, but it could be more or less depending on, among other things, the branch of service you choose, your rank, and length of service.

The Reserves won't make you rich, but after 20 years, you'll be eligible for a military pension. In addition, if you're called to active duty for longer than 30 days, you and your family will qualify for health care and low-cost dental and life insurance. As a further incentive, the Army and Navy offer recruitment bonuses (up to $30,000) and tuition repayment (up to $50,000) to specialists they're particularly in need of. Earlier this year, for instance, the Army National Guard, a reservists-only branch of the Army, was paying bonuses for family physicians and internal medicine subspecialists, including cardiologists, gastroenterologists, and infectious disease specialists. Those monies can provide welcome relief to a young physician who has lots of student loans or is starting a family.

While the perks are nice, there's always the chance that you'll be called to active duty and sent to a war zone. (As of June 5, more than 83,000 reservists—including about 12,000 physicians—were on active duty.) So if you can't stand the thought of being separated from your home and family for an extended tour of duty, think twice about enlisting.

And remember, once you're in, it's not so easy to resign. One Oklahoma general surgeon learned that the hard way. Heeding his wife's pleas, he sent in his resignation the day after Saddam Hussein invaded Kuwait, on Aug. 3, 1990. By the time the military responded to his certified letter, Operation Desert Shield had been launched and all leaves, resignations, and reassignments were put on hold. He was sent to a post in Kentucky, 1,000 miles from home. It was four months before he was deactivated.

Weigh the costs carefully

Bonuses and tuition repayment may be tempting, but for some physicians, there may well be financial drawbacks to serving in the Reserves. Consider what happened to Jack Chitwood: Full of pride and patriotism, the orthopedic surgeon served five months during the Gulf War as a reservist with the Army National Guard. When he returned home to Abilene, TX, in May 1991, Chitwood found that his practice was deep in debt. Not only had his accounts receivable dried up, but many patients had found new doctors.

"I was earning $10,000 a month in the military, and my monthly bills, including personal debts and practice overhead, totaled $20,000," Chitwood says. "When creditors threatened to sue unless I paid up, I had no choice but to declare bankruptcy. I'd gone through all of my personal savings trying to rescue my practice.

"I assumed," he continues, "that Congress would take care of us physicians when we got home, by enacting laws that would allow us to secure no-interest or low-interest loans. Obviously, I was naive." (The government has since enacted just such a program. See the next section for details.)

Even if he'd had the financial help he expected, out of sight is out of mind. It took Chitwood about 18 months to rebuild his referral base and restore his income to pre-active-duty levels. The Oklahoma general surgeon mentioned earlier had similar problems; he estimates he lost $100,000 in income, and his referral base shrank significantly, as well. Like Chitwood, it took him more than a year to restore his practice to where it had been before he left for active duty.

While Chitwood harbors no resentment toward the Army National Guard, he says stories such as his have made it difficult for the military to attract physicians to the Reserves. Uncle Sam won't make your payments on your house or car, or pay down your kids' tuition. You'll continue to be responsible for those debts, so make sure you've accumulated several months' savings and have assigned someone to pay the bills while you're on active duty. You may also want to grant this person power of attorney.

There are some federal laws that protect reservists on active duty from economic hardship: In certain situations, a landlord can't evict you; creditors can't charge more than 6 percent annual interest on your consumer loans; and you can't be found in default for failure to appear in court. Ask your recruiter for more details on these protections before you sign up. Also, check with your malpractice insurer to see if it will suspend your premiums during active service.

If you're in a group practice, check to see that your employment or partnership agreement has a provision for military leave. At a minimum, you must be guaranteed your job when you return, in accordance with federal law. For more information about many of your rights, check out the Web site of the National Committee for Employer Support for the Guard and Reserve (www.esgr.org ).

Some groups choose to go beyond the requirements. A large multispecialty practice, for instance, may offer to pay some or all of your salary and retirement benefits and continue your health and disability coverage while you're on active duty. Of course, those aren't options for soloists. The best a soloist can do is arrange for a locum tenens to see your patients and thus preserve your practice.

A response to calls for relief

The Army learned a valuable lesson after the Gulf War. "The guys who took the biggest bath in the Gulf War were the doctors," says retired Brigadier General Dave McGinnis, of the New York Army National Guard, in recent comments posted on a financial-services Web site. As a result, physicians fled the Reserves in droves; at one point during the 1990s, two doctors left the Army Reserve for every new one recruited.

So the Army made some changes. For physicians, dentists, and nurse anesthetists, the mandatory number of consecutive days on active duty has been shortened from 270 to 90. (High-ranking officers, such as commanders of medical or nursing units, are still required to serve 270 consecutive days.) While that policy reduces the burden on individual physicians, it increases the numbers who will be called to active duty if the need arises. And it doesn't rule out serving multiple tours. In September, the Army will issue a report detailing how the shorter tour of duty affected recruiting and retention, and whether it should be continued.

The government has also heard physicians' calls for financial relief. Through the US Small Business Administration, low-interest loans (not to exceed 4 percent) of up to $1.5 million are available to reservists for 90 days after discharge from active duty. The term of the loan, which can run as long as 30 years, is based on each applicant's ability to repay. These loans are intended to cover overhead and other short-term debts, not long-term obligations or lost income or profits. For more information on this program, go to www.sba.gov/disaster/general.html .

Physicians who've served in both the Gulf War and in Afghanistan say the changes have helped ease their financial burdens. Yet most say the opportunity to serve their country far outweighs any income considerations. "I don't mind the sacrifices," says a Pennsylvania vascular surgeon. "They're small compared to what some soldiers are giving."

*The Reserve components of the US Armed Forces are: the Army Reserve, the Army National Guard, the Naval Reserve, the Marine Corps Reserve, the Air Force Reserve, the Air Force National Guard, and the Coast Guard Reserve.

Serving in the Reserve: the basic requirements

In order to sign up, you must be a US citizen or permanent resident. At the time of your appointment, you must be younger than 47 to qualify for the Army, and younger than 40 for the Navy. (Older applicants can apply for an age waiver.) You need to have graduated from an accredited US school of medicine or osteopathy and hold a valid, unrestricted medical license. Some exceptions are made for graduates of foreign medical schools; ask a local recruiter for details.

You'll have to undergo a background check and pass a physical. For Army recruits, the whole process—from your initial meeting with a recruiter to the time you become a commissioned officer—takes about three months. It could take as long as six months for the Navy. Here's where to get more information:

Air Force Reserve (800-257-1212; www.afreserve.com )
Air National Guard (800-864-6264; www.goang.com)
Army National Guard (800-464-8273; www.arng.army.mil)
Army Reserve (800-872-2769; www.goarmyreserve.com)
Coast Guard Reserve (877-669-8724; www.uscg.mil/hq/reserve/reshmpg.html)
Marine Forces Reserve (800-627-4637; www.marforres.usmc.mil)
Naval Reserve Force (800-872-8767; www.navres.navy.mil )

Dennis Murray. Is now the time to consider the military?.

Medical Economics

2002;13:54.