Page 20 - JSOM Fall 2024

Military Medical Student Specialty Preferences
During the DHA Transition

A Retrospective Analysis

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Zechariah S. Brooke, MD, MS *; Christopher M. Husson, MD ; Rachel L. Watkin, MD ;
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Kent W. Swats, MD ; Nicholas A. Moran, MD ; Sorana Raiciulescu, MSc ;
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Catherine T. Witkop, MD, PhD, MPH ; Steven J. Durning, MD, PhD, MACP 8
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ABSTRACT
Background: The Military Health System is a unique subsector been found to strongly correlate with higher earning poten-
within the nation’s Graduate Medical Education (GME), with tial and limited position availability. This supply and de-
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a different incentive structure for specialty selection for mil- mand model is the construct that most medical students use
itary medical students compared with their civilian counter- to deliberate about future specialties, weighing preference and
parts. Changes by the Defense Health Agency (DHA) in 2017 competition. 1
emphasized a shift in military GME to training “operational”
medical specialties. This study sought to gain insight into mil- Conversely, the Military Health System (MHS) and its Grad-
itary medical students’ reactions to the 2017 DHA transition uate Medical Education (GME) programs provide a natural
by examining whether students continued to select “opera- experiment in which military medical students may be less
tional” specialties at similar rates as well as whether students motivated by financial factors. The military pays for medical
remained satisfied with attending medical school. Methods: school costs, dramatically reducing student debt, and offers
We performed a retrospective analysis of Uniformed Services residents a competitive salary based on rank. After GME
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University (USU) post-match students from 2015 to 2020 us- training and before retention bonuses, a military physician’s
ing anonymized data from the Association of American Med- compensation is largely based on rank, the location they are
ical Colleges (AAMC) Graduation Questionnaire, separated currently serving in, and time in service.
into pre-DHA (2015–2017) and post-DHA (2018–2020)
transition groups. Results: Regarding both intent to practice To best understand the difference between military and civil-
an operational specialty and satisfaction with choosing medi- ian medical students, it is important to briefly discuss the path-
cal school, there was no statistically significant difference be- way to becoming a military physician in the United States. The
tween the pre- and post-DHA transition groups. Conclusions: vast majority of active-duty military physicians are graduates
Whether pre- or post-DHA transition, USU medical students of the Uniformed Services University of Health Sciences (USU)
demonstrated similar preferences for operational specialties as or recipients of the Health Professions Scholarship Program
well as similar levels of satisfaction with medical school at- (HPSP). Both USU and HPSP medical students incur a mili-
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tendance, suggesting that this transition may not significantly tary service obligation (MSO), an amount of time a physician
influence medical students’ career preferences nor blunt their will be obligated to serve in exchange for tuition, stipend, and
desire to enter military medicine. education. Students who matriculate from USU currently incur
a 7-year MSO (as USU students also receive a salary based
Keywords: military medicine; medical education; Defense on rank), whereas students matriculating from HPSP incur a
Health Agency; military medical students; Uniformed 4-year MSO. 3
Services University; Graduate Medical Education; internship
and residency Thus, military medical students may be less influenced by
earning potential when selecting a specialty. For example, one
study demonstrated that a higher proportion of USU students
selected family medicine compared with students in the rest of
Introduction
the nation. This same study also suggested a steadily increas-
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Many factors influence medical student specialty selection in ing trend of USU students opting for primary care specialties
the civilian sector. Numerous studies have examined potential from 1980 to 2009. A separate study examined the specialty
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influences on medical student career selection, most focusing preferences of fourth-year medical students going into mili-
on salary potential, perceived quality of life, job satisfaction, tary service after graduation; this study demonstrated that
or work environment. The most competitive specialties have radiology, ophthalmology, dermatology, and anesthesia were
*Correspondence to zechbrooke@gmail.com
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1 LT Zechariah S. Brooke is a PGY-1 in the Transitional Internship Department, Naval Medical Center Portsmouth, Portsmouth, VA. CPT
Christopher M. Husson is a PGY-4 in the Department of Radiology, Tripler Army Medical Center, Honolulu, HI. CPT Rachel L. Watkin is
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a PGY-1 in the Department of Obstetrics & Gynecology, Joint Base Lewis-McChord, WA. CPT Kent W. Swats is a PGY-1 in the Department
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of Anesthesiology, University of Texas at San Antonio, San Antonio, TX. CPT Nicholas A. Moran is a PGY-4, Department of Medicine, Joint
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Base Lewis-McChord, Madigan Army Medical Center, WA. Sorana Raiciulescu is a staff biostatistician affiliated with the Uniformed Services
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University of Health Sciences, Bethesda, MD. Col (Ret) Catherine T. Witkop is Associate Dean of Medical Education at the Uniformed Services
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University of Health Sciences, Bethesda, MD. Dr. Steven J. Durning is Director of the Center for Health Professions Education and Vice Chair of
the Department of Medicine at the Uniformed Services University of Health Sciences, Bethesda, MD.
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