What physician practices should know before hiring a military doctor

This article is aimed primarily at physicians in organizations or medical groups that are considering adding a physician with military experience. What do you know about their medical and military lives?

First, you should understand whether they served on active duty (full time), in the Reserve or National Guard (part time) or, commonly, both (an active-duty career followed by Reserve duty). Let's discuss active duty first.

Many physicians agree to several years of active duty in exchange for medical school scholarships or even admission to the military's own medical school. In this way, they avoid the often-crushing debt that comes with even state schools now. They are technically commissioned as officers during medical school but at most have to complete a few weeks of officer training during those years. After medical school, they may be able to choose a civilian residency, but in some cases the military will have them serve as a general medical officer for a few years after an internship. The military also wants to fill its own residencies with these physicians in the specialties it wants and needs. During residency, military duty is usually significantly limited (except in military residencies). After residency and fellowship training, the physician is usually a captain (the Navy, which also provides physicians to the Marine Corps, uses a different rank system) and is assigned to duty where the military wants them (there might or might not be a choice). Duty assignments are usually two to three years and might be at a domestic military base or overseas. Combat-zone deployments are shorter. In some specialties, the clinical experience at a domestic military base is not enough to keep skills current, and it is not unusual for these physicians to work in civilian hospitals at the same time.

I found most active-duty physicians enjoy their work, often with a camaraderie not seen in private practice. However, they understand that their compensation is usually well below what they could earn in the civilian world, depending on their specialty.

The active-duty physician on scholarship usually has a payback period of four or more years, after which they can leave the service. Many of these physicians also get "credit" for some of their school and residency time toward retirement pensions, so many switch to the Reserve at this point (more on that below).

Reserve and National Guard duty are similar in experience and are usually part time (flight crews, support and some administrative positions are full time). Typical Reserve duty is training at a military base one weekend a month plus an expected two weeks of full-time training or work each year. Reserve units have different policies about involuntary overseas deployments, and I found that, at least in the Air Force, physicians were usually asked rather than ordered to work overseas. In the past, physicians from almost any specialty could serve in the Reserve, but it is more common now for the military to take only the specialties it needs at the time.

If you are considering working with or hiring a physician in the Reserve, you should understand their obligations and honor their commitment to the country. Some employers are exceptional in this support (especially the VA), including making up salary differences during deployments.

Physicians in the military have different age guidelines than the nonmedical community. Because physicians are usually in high demand, they can get waivers to enter service much later than usual and to leave much later. (I started at age 50 and served until age 67.)

Reserve physicians get access to low-cost Tricare health insurance for their families and a small government contribution to a 401(k)-style retirement account, but otherwise very low pay for their time. They are also eligible for lower-cost VA home loans. But any real financial benefit comes only after at least 20 years of combined active and Reserve duty.

Active-duty physicians who entered service before 2006 and served at least 20 years get an immediate pension on discharge that is based on their highest basic pay (about half of that pay at 20 years of service). They also get lifetime Tricare coverage, VA home loans and VA medical care, mostly for service-connected injuries or illnesses. If they entered service after 2006, they still receive a pension and usually also get some annual 401(k)-style contributions from the government.

Reserve physicians and those with mixed active-duty and Reserve service usually do not get retirement benefits before age 60, when they begin receiving a pension that varies with the number of years served in each capacity. They do not get any pension or retiree Tricare benefits unless their combined service totaled at least 20 years.

I hold my fellow military physicians in the highest regard and hope you enjoy working with them.

Steven Podnos, M.D., CFP, practiced pulmonary and critical care medicine in private practice as well as serving more than 15 years in the U.S. Air Force Reserve. He left the service in 2023 at the rank of colonel after serving as a Critical Care Air Transport Team physician and a flight surgeon. He is now a full-time, fee-only fiduciary financial planner with HB Wealth and can be reached at steve@hbwealth.com.