Introduction: The path to military neurosurgical practice can include a number of accession pathways. This paper is an objective comparison of the fiscal, tangible, and intangible benefits provided through different military neurosurgery career paths and those of civilian practice.
Methods: Neurosurgeons may train through full time military active duty training, the Navy Active Duty Delay for Specialist Program (military sponsored civilian training), Navy Reserve Training in the Medical Specialties Program, or civilian neurosurgery. These modalities were evaluated on the basis of economic data during residency and the initial three year service commitment following. Where applicable military base pay, basic allowance for housing/subsistence, variable special pay, board certified pay, incentive pay, multi-year special pay, reserve drill pay, civilian salary, income tax, and other tax incentives were analyzed using publicly available data regarding military pay charts and tables.
Results: Active duty neurosurgeons garnered $1,479,494.32 in effective income during residency and the three years immediately following. Civilians earned $ 1,947,048.00 in that time; military sponsored civilian training received $ 1,015,934.88, and reserve service generated $ 2,042,993.81. Civilians had lower residency pay, higher starting salaries, increased taxes, malpractice insurance cost, and increased overhead. Active duty service saw higher residency pay, lower starting salary, tax incentives, increased benefits, and almost no associated overhead including malpractice coverage. Reserve service saw a combination of civilian benefits with supplementation of reserve drill pay in return for weekend drill and the possibility of deployment and activation. Intangibles include esprit de corps, humanitarian, leadership, and operational opportunities.
Conclusions: Being a neurosurgeon in the armed services is extremely rewarding. From a financial perspective, ignoring intangibles, this article shows an expected fiscal parity between the cumulative salaries of active duty and civilian career paths while highlighting the reserve service option. We hope that those curious about or considering undertaking service in the United States military benefit from our accounting and review of these comparative paths.
Patient Care: Educate neurosurgeons about the benefits of military service. Indirectly encourage increased neurosurgeon participation in the armed services.
Learning Objectives: 1) Discuss the options available for military service as a neurosurgeon
2) Discuss the benefits and limitations of active duty and reserve neurosurgery service
3) Discuss the non-economic benefits to military service as a neurosurgeon
References: References:
1. American Association of Medical Colleges: Medical Student Education: Debt, Costs, and Loan Repayment Fact Card. 2013 Available: https://www.aamc.org/download/152968/data/debtfactcard.pdf.
2. Jena AB, Seabury S, Lakdawalla D, Chandra A: Malpractice Risk According to Physician Specialty. N Engl J Med 365:629gl J Medabu3.
3. LSUHSC-S: Compensation and Benefits. 2014 Available: http://www.lsuhscshreveport.edu/Resource.ashx?sn=CompensationandBenefits.
4. McCafferty R: SAFCS Neurosurgery Services. 2011
5. Military Times: 2013 Medical and Dental Special Pays. 2012 Med Dent Spec Pays:2013
6. MilPayTable 2014:2013 Available: http://www.dfas.mil/militarymembers/payentitlements/militarypaytables.html.
7. Moquin RR, Ecklund JM: Socioeconomic issues of United States military neurosurgery. Neurosurg Focus 12:e6, 2002
8. Nahed BV, Babu MA, Smith TR, Heary RF: Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons. PLoS ONE 7:e39237, 2012
9. Nanda, Anil: LSUHSC Presentation to Prospective Residents. 12/13
10. Navy Reserve Pay and Benefits:Pay Benefits:2014 Available: http://www.navyreserve.com/benefits/pay.html.
11. Ragel BT, Klimo P Jr, Grant GA, Taggard DA, Nute D, McCafferty RR, et al.: Economic analysis of the military health professions scholarship program for neurosurgeons. Neurosurgery 69:525osurgerylimo P n 531–532, 2011
12. Ragel BT, Klimo, Paula: Effect of Neurosurgeon Turnover an Deployments on Case Volume at a Military Hospital, 2001-2008. AANS Neurosurgeon 19:36S Neurosur13. Ragel BT, Klimo P, Kowalski RJ, McCafferty RR, Liu JM, Taggard DA, et al.: Neurosurgery in Afghanistan during “Operation Enduring Freedom”: a 24-month experience. Neurosurg Focus 28:E8, 2010
14. Ragel BT, Klimo P, Martin JE, Teff RJ, Bakken HE, Armonda RA: Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus 28:E2, 2010
15. Ragel BT, Taggard DA, Klimo P, Liu JM, Robison S, Sholes AH: Increasing the neurosurgical caseload at a military hospital: initial experience with a joint military-Veterans Affairs (VA) sharing agreement. Mil Med 174:103MedBT, Tagg