Financial Implications of Leaving a Military Medicine Position

Today’s Saturday Selection from the White Coat Investor is a nod to current and former members of the military on Veteran’s Day. From both of us, thank you for all that you’ve done and continue to do to keep our nation safe and free!

Dr. Jim Dahle, the author of this post, has experience as both a military and civilian physician, making him particularly qualified to explore this topic.

This post originally appeared on The White Coat Investor in 2012, and has been partially updated for 2017.

As noted by commenter Mike below, there have been additional changes in the last five years that should also be taken under consideration, including changes to Military Specialty Pay. You can also download the Medical Corps Specialty Pay Guidance document here. Please contact me with additional considerations and I will add them to this post.


 

I had a question that I’d been meaning to address as a blog post.  By the time I had the email answered, most of this post was written.  Just about every military physician contemplates this question multiple times during his career.   You’re basically weighing the lower salary and additional hassle of military practice against losing the extremely valuable retirement pension (with Tricare for Life) available after 20 years of service.

 

It’s Not A Financial Decision

 

Before moving on to the financial implications of this decision (that you’re all so interested in), I’d just like to emphasize that this is not primarily a financial question.

Many, perhaps most, military doctors get out as soon as their required educational debt is paid off, often after 3-8 years.  They do so not just because they desire higher pay but because they don’t enjoy the frequent deployments. They also don’t want the military telling them where to live or moving them frequently, or they hate the unique hassles of military life and medical practice.

Those were certainly my motivations when I separated a couple of years ago.  I often came home back then saying “I hate my job”, and never do so now.  I get to live where I want and never get someone calling me up at 11 pm letting me know I’m deploying halfway around the world tomorrow (a call I actually did receive while in the military).

Likewise, people stay in the military for non-financial reasons.  They are motivated by patriotism, opportunities for leadership, unique medical opportunities, job security, and the opportunity to have a practice composed nearly entirely of patients who have made a commitment to put their country first.  But, if you’re still interested in a financial discussion of this topic, read on.

 

What’s the Pension Actually Worth?

 

Too few doctors actually understand what they’re giving up by separating.  In fact, once you do, you would have to absolutely hate being in the military to separate at any point after earning 8-12 years toward the retirement pension.  The pension a doctor receives after 20 years in the military is equal to 50% of his base pay, averaged over the three years prior to retirement.

Most docs retire as O-5s or O-6s.  An O-6 with 18 years of service (in 2017) makes $9,543 per month or $114,516 per year, and it goes up just about every year.  50% of that is $57,258.

Also, consider the value of having health insurance covered for the rest of your life.  That’s hard to put a price on, but a reasonable amount to spend on health insurance premiums, co-pays, and deductibles is $1000-2000 per month, or $12-24K per year.  Let’s use $18K.  Add that to your $57,258 and that’s a value of $75,258 per year, adjusted each year for inflation. How much would it cost me to purchase that pension as a civilian from a private insurance company?

It depends on your age, gender, and health, but assuming a 50-year-old healthy male, you could purchase that annuity for about $2.5 Million.  Yes, you read that right.  That’s a pretty valuable pension, no? [PoF: This is consistent with a thorough analysis done here at Navy Medical Corps Career Blog in 2016, which valued a pension at somewhere in the range of $1.2 to $2.5 Million]

It would be a little less as an O-5, and who knows if Congress will change the rules on the pension in the future, but I wouldn’t expect this very popular pension to go away anytime soon, especially for those currently in the military.  It could also be significantly less if interest rates go up.  But even if somehow inflation-indexed annuities that paid 5% at age 50 (they currently pay 2.88% or so) became available, that pension would still be worth $1.43 Million.

 

Break-Even Point

 

Years Left To Retirement Required Annual Savings
16 $100,000
12 $150,000
8 $249,000
4 $550,000

In order to come out ahead separating from the military, you not only need to make more money as a civilian, you need to make a LOT more money AND be disciplined enough to save it.  How much more do you need to save each year to have an additional $2.5 Million by the time you would have otherwise retired?  (This obviously is in addition to anything you’re putting in Roth IRAs or the TSP currently.)  I’m assuming a pretty decent 5% after-inflation, after-expense, after-tax return on these savings as well, which is not necessarily easy (my own portfolio over the last 8 years is clocking in at about 4.5%.)

Pretty sobering, isn’t it?  Now you see why I think someone who’s anywhere near the halfway mark would be pretty foolish to bail out now.

 

world war II museum

 

Don’t Forget About Current Consumption

 

Now, I had 16 years left to retirement when I got out.  I certainly make more than I would have been making in the military, but I also pay more of it in taxes, and I don’t save $100,000 more than I was saving.  I save perhaps $50,000 more.  But I also spend a lot more due to a much-improved lifestyle and give a lot more to charity.

Overall, I’m probably coming out slightly ahead.  But that’s in a pretty good job, in a reasonably high-paying specialty, and I got out at only 4 years towards retirement.  Change any of those factors and you’re almost surely coming out behind.

Perhaps you can stomach one or two more deployments, no? There is some value in having the money now, of course.  I probably wouldn’t own my current home on a military physician salary, at least not given my current savings rate (although I could probably lower that dramatically if I had a military pension coming).

Nor could I afford to do lots of the other things I enjoy.  Putting all that off for 16 more years to live in townhomes in cities I don’t want to live in was a pretty unappealing prospect.  Many doctors would prefer having an extra $100K now to spend on whatever they want than some “valuable pension” 16 years down the road, but they probably shouldn’t.

 

Calculate the Difference in Tax-Adjusted Salaries

 

So, will this fancy civilian job you’re considering getting out of the military for pay you enough additional money to save up the equivalent of that pension?  Maybe, but probably not.

First, calculate what you’d get paid to stay in.  Since your educational commitment is now up, you should get some kind of Multi-Year Special pay in addition to all the pays you were getting before- Basic Pay, BAH, BAS, Additional Special Pay, Variable Special Pay, Board Certified Pay, and Incentive Special Pay.  Add it all up.

Now, adjust for taxes.  This is so personalized, it is hard to apply a rule of thumb.  But I can tell you that when I was in the military I had no state tax and my federal tax was 5-6%.  Now I pay about 12% between Federal and State and it’ll probably be higher than that this year and significantly higher next year.

Many doctors tell me they pay between 20 and 30% just in Federal and State Tax.  You also probably pay a little more in payroll taxes outside the military.   So let’s discount the military salary by say 10% and the civilian pay by 23% for taxes.  Now compare the two.  Are you really going to be able to put away an additional $100-$550K?  Perhaps if you’re a back surgeon, but almost surely not if you’re a pediatrician.

Let’s do an example using my specialty, emergency medicine.

An O-4 with greater than 6 years toward pay (what I had when I got out) made the following salary in 2012:

  • Basic Pay $68,137.20
  • BAH $26,400 (obviously varies by location)
  • BAS $2879.52
  • VSP $12000
  • ASP $15000
  • BCP $2000
  • ISP $26000
  • MSP $40,000 (plus another $4000 in ISP once you sign the MSP contract)
  • Total: $194,416.70

Now, I participate in two surveys of emergency medicine salaries each year.  One said the average salary is now $237,000.  The other said the average salary was $330,000.  Salary.com says it is $250,000.

I think a partner in a private emergency medicine group, working as hard as I did in the military (far harder than I work now) should probably be able to find a job making at least $350,000 in most areas of the country (although who knows what’s going to happen in the future.)

Let’s adjust both for taxes.  We’ll subtract out 23% of civilian salary and 10% of the military salary:

  • Military: $174,975
  • Civilian: $269,500

You don’t make an additional $100K, so how are you going to save an additional $100K+?  Well, you could do it if you had some good tax-protected accounts that also lowered your tax bill.  But the point is that it would be hard to do, and pretty much impossible once you start getting close to the 10-year mark no matter what your specialty, especially if you consider the fact that most civilian physicians believe they’ll actually be making less 5 years from now.  How many military physicians believe that?  Pretty much none given the regular guaranteed raises.

 


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Conclusion

 

Staying into the 20-year mark is probably the right move financially for almost all military physicians, especially since many of them who did military residencies may have 6, 8, or even 10 years toward retirement by the time their educational commitment is up.  An exception can be made for very high paying specialties, especially if interest rates rise, but not once you approach that ten-year mark.

As I mentioned at the beginning, this is not primarily a financial decision.  Hopefully you didn’t join the military primarily for the money, and hopefully, you’re not staying in primarily for the money.  But if you do decide to serve for a few more years, you can at least feel good that you’re being compensated well for it.

 

What do you think? Did you leave military service early, at the mid-point, or stay past the 20-year mark? How did your decision to stay or separate affect your finances? Comment below!

23 comments

  • Mike

    I’m a navy doc, approaching the end of my commitment. I’ll be at 10 years to retirement. Articles like this are quite valuable, particularly for the calculations. However, this article is extremely outdated. The information may have been relevant in 2012, but what exactly was “updated for 2017”? The new military medicine speciality pay structure has been in effect for over a year now, which significantly changes the math. The most notable change is the eligibility date for MSP (multi year specialty pay, the bonus you get for agreeing to extend your commitment for 1-4 years). It used to be possible to sign for MSP any time after graduating residency as long as you had 6 years service. However, in the new system, you are not eligible until after your initial obligation is paid back. Using your example of $40k, that could be a difference of $160k (even more in the highest paying specialities). This is most particularly important for doctors considering fellowship, trying to decide between staying in or getting out.

    Military physicians are a unique group in dire need of financial guidance. Articles like this can be invaluable for us, but outdated information is a confusing disservice. I’ve been following some of the other blogs that focus on military, I hope they can pitch in to help, especially right now, with the new Blended Retirement System right around the corner.

    • Thank you for the comment, Mike. Also, thank you serving our nation, and for helping to improve today’s post..

      I’ve updated the introduction to note that additional changes have occurred since the original publication, but the main update we made was making the O6 pay scale current. I think the concepts outlined by Dr. Dahle are valid, but the numbers will have to be altered for each individual doc. And, of course, it’s not just about the numbers.

      I’ll be happy to incorporate other updates sent my way.

      Best,
      -PoF

      • ArmyDoc

        1) @WCI – still an AWESOME summary- Loved seeing it again!
        2) @PoF – thanks for running this on Veteran’s Day – you rock
        3) @ Mike – a few things to keep in mind that could help you
        A) Post 9/11 GI Bill – used it to send my kid to Duke; with Yellow Ribbon matching from VA it was overall worth about $180K. Not Taxed. See Dr Dahle’s comments above about how much you would need to make to have this amount based on different marginal tax brackets, but make sure you have this squared away before you bail out.
        B) Fellowship – interestingly if you don’t go straight through from residency and if you pay off your initial obligation and then start an MSP prior to fellowship, your obligations are CONCURRENT. Google this and be amazed. I made $170K a year as an Army sponsored fellow – no decrease in standard of living for my family while I did a fellowship. YMMV based on your MSP, but this was back in 2006 so almost certainly higher for you now.
        C) Where you will be stationed – fellowship may limit you to academic centers depending on specialty. If you are ‘limited’ to being stationed in San Diego, DC, or Portsmouth by getting highly paid to do training that will make you even more highly paid — that might not be too bad…I love all those areas.
        D) Need for advice – you actually may not need more guidance. As WCI and Nords from Military Guide often state- only stay in if you love what you are doing. The money isn’t worth it. Your options are both awesome.

        Hope this helps! @PoF I don’t know if you are allowed to, but feel free to pass my e-mail to Mike if he would like to dig into this further with me.

        • Mike

          ArmyDoc~

          I agree, thanks to PoF and WCI for posting articles like these. We’re a special group with special considerations and it’s always nice to get good advice.

          Post 9/11 GI Bill – agree completely! Due to my GMO tour and specialty choice, I knew in advance that my payback would land me at the 10-year mark (minimum to transfer the benefit to your kids). I signed the transfer paperwork the day I hit 6 years (the soonest you can). I am so grateful for this benefit. It amazes me that so few military docs understand how to do this. Part of the issue is the requirement to be in for 10 years, and that you have to remain in for 4 years after transfer (thus the transferring at the 6 year mark).

          The recent specialty pay change hasn’t changed the basic numbers by a whole lot (decreased $4k/yr for my specialty, thanks Navy). However, the biggest change is not being eligible for MSP until AFTER initial payback, which means you can NOT take MSP during fellowship, as you did. That was a great deal, and definitely changes the calculation. My point is that now the scales are tipping the other direction.

          The bottom line is: I don’t think the math favors staying in as strongly as it used to. WCI made the point that once you’re in for 6-10 years, it makes sense to stay in. Nowadays, it’s probably more in the 10-14 year range, depending on specialty and personal factors. I’ll be at the 10 year mark, in a high paying specialty, so for me it’s hard to make the case to stay in. I’m not anti-military, I’ve thoroughly enjoyed my time in, but there are certainly a lot of downsides to military life, which do take a toll.

          • Andrey

            How would the numbers shake out for a radiologist who will have 12 years in at commitments end? Assume I would be equally happy working as AD and a civilian. Also assume that a radiologist works at least twice as hard (volume) on the civilian side in the current market. This last point of course doesn’t affect the hard numerical data.

    • I’ve been posting for the last week about the new pay system on my career planning blog for Navy physicians (MCCareer.org), and I think it can be summarized in one word…confusing.

      That said, the new rules about when you are eligible to take the MSP does change the math a little, but in my opinion not dramatically. In the old system, if you took an MSP while you still had a commitment, you got the MSP early but you had years at the end of your commitment where you’d have to go without it. In other words, you pay rose sooner but at the end it would decrease for the duration of your remaining commitment. Money now is more valuable than money in the future, so taking the MSP early was almost always the right financial move, but it wasn’t what I (and many others) did.

      I did not take my MSP early, and instead waited until my commitment was up. This was not financially wise, but I often tell people who are weighing the get in vs get out decision that they really won’t know what they want to do until they actually face the decision. For this reason, I didn’t take an MSP early. I wanted to have my commitment run out (which it did at the 10 year mark) and then see what I wanted to do. I stayed in, but only after actually routing a resignation request and having my civilian job fall through. Once I decided to stay in, I took the 4 year MSP.

      I also didn’t want to take it early because then your pay dropped right when your kids were older, perhaps in college. And back then you couldn’t transfer your GI bill to your kids, so you were paying for college. Nothing like a $40K/year pay hit while your kids are in college! No thanks.

      So, bottom line for me is that the new rules don’t change the stay in vs get out calculous all that much. That said, everyone has their individual situation and what is important to one person differs from what is important to another.

      Thanks for running the post. Although some of the details are dated, the general message that the military pension is valuable is true. Those interested can read my own thoughts on it here if they wish:

      https://mccareer.org/2016/03/20/how-valuable-is-a-military-pension/

      • Thank you for the comments and your detailed analysis in the link. I’ve added it to the article.

        I found it interesting that WCI’s pension value falls in the range (at the top end) of your calculations. That is one valuable pension, and definitely worth more than most docs will have accumulated for retirement over a 20-year career.

        Finally, thank you for your service!
        -PoF

      • Dusty

        The MSP/RB change did not close out the so called “fellowship loophole” where you can take a RB and pay it back concurrently with fellowship obligation.
        To be eligible you have to meet all of the following requirements:
        1. Be at 8 or more years time in the Medical Corps
        2. Have completed all pre-commisioning obligation time
        a. HPSP/USUSHS/HSCP and any obligation from ROTC/USNA
        b. Does not include residency obligation time
        Basically if you did a 4 year HPSP and have completed or will have completed 4 or more years before going to fellowship of combined GMO and post-residency payback time, you should be eligible if you’re at or 8 years.
        The loophole is if you sign a Retention Bonus before you start your fellowship, you can pay back your Retention Bonus obligation during fellowship and concurrent with your fellowship payback obligation.

        To find out if anyone is eligible, email the bumed special pays people: [email protected]

        More info here: http://www.med.navy.mil/bumed/Special_Pay/Pages/default.aspx

        I didn’t even think this was a possibility until a colleague of mine read through the 80 page document Mark Sullivan sent out. Its going to end up being a $141,000 swing for me with a 3 year MSP without increasing my get out of the Navy date.

  • The “It’s Not a Financial Decision” point should be emphasized more when considering any military service. For me personally, I would not be willing to take orders that could potentially risk my life or the lives of others in order to improve my financial status. I know this is a deeply personal decision and plenty of others would feel differently. It’s also easy for me to say when I grew up in a standard comfortable middle class lifestyle and have never been in danger of going broke, etc. Thanks for bringing that up first.

  • Aninabobina

    I retired from Active duty almost 10 years ago.

    I love being retired. I love getting paid to breathe. It is fantastic. I can live off of my retirement check. The civilian paycheck I get now is being put to work.

    In fact, I can retire again. The only reason I don’t is for my office staff. If I quit, they may struggle. Many of them are my age or older, and getting a job after 50 is hard. I have patients who won’t see anyone else, and in fact, a few followed me from the military.

    I am now trying to figure out how I can take my little pile of cash and turn it into a charity foundation like Bill Gates or Warren Buffett (I want to make my community better). That’s why I follow you and Dr. Dahle.

    • ” I love getting paid to breathe. It is fantastic.”

      Gotta love that passive income. You activly earned the right to it, but now it’s mailbox money. Good for you.

      I also admire your charitable aspirations. I’m a fan of the donor advised fund, and I’ll be publishing a post from WCI on additional options later this month.

      Cheers!
      -PoF

  • ArmyDoc

    Oops
    Commented but failed to answer the question at the end of the article –
    I did stay in past my commitment, then past my 20 year “vesting” in the retirement.
    I kept getting assignments I really liked – Germany, DC, Army sponsored fellowship in San Francisco, DC again, and now Hawaii. I have only been deployed twice, and only 6 months each time.
    I love teaching residents, and the pay differential between my military salary ($296K last year, with $64K of that non-taxed) and a civilian academic appointment is pretty inconsequential.
    If any of the factors above had not happened, I would have left the service sooner.
    Interestingly, the retirement increases 2.5% per year (soon to be 2% for those entering service now). But the “base pay” also increases every 2 years so the retirement increases in a non-linear rate. So my 30 year retirement (75%) of my Base Pay (O6 over 28 years $133,272) starting at age 56 will be about $99K per year (pre-tax, pre-Survivor Benefit election) with an annual inflation adjustment. This is a great “floor” for retirement, and allows me to sleep at night while staying 100% equities in my TSP, IRA’s, spouse’s 403b and 457b, etc through the bear markets since starting my investing career.
    In terms of staying in affecting my finances – I think I have made less but not in any way that affects my lifestyle, and knowing me I doubt I would have saved all the pay differential to make up for the retirement loss. I think Dr Dahle is right – once you get past 10-14 years, the money+the psychology really add up to consider staying in.
    Sorry about using real numbers – definitely not bragging. This is all publicly available information at http://www.dfas.mil. Also many of my civilian colleagues make waaay more than me – especially outside academia.
    🙂

    • Thanks for the update, ArmyDoc, and I appreciate the real numbers. I don’t think anyone sees that as a brag — these numbers are publicly available as you mention.

      Those are some great assignments, and I can see why you’ve continued to work. If it’s work you love in great places, you absolutely should continue to build up your retirement accounts and future pension. The deployments can be rough — I’ve read a detailed written account from an anesthesiologist who spent time in the middle east — but I could deal with Hawaii.

      Aloha!
      -PoF

  • Gasem

    Thanks PoF for this post. I was in med school in 1981. I had saved enough to pay for the 4 years out of pocket so I was set or so I thought. It was the age of inflation. My tuition nearly doubled between my acceptance and my matriculation and it went down hill from there. By the end of my second year I was out of dough and NOWAY was I taking out an 18% compounding starts immediately loan. So I raised my right hand swore to defend the constitution with my life and I was Anchors Aweigh.

    If you think about what I just wrote the service saved me from a 18% killer loan. I traded one kind of indebtedness for another, IMHO a great trade since I learned a lot in the service, hoovered up whatever they had to offer in terms of training, plus I got paid, and I came out debt free. I don’t see the treatment of debt and free training in this analysis. In the service you have access to the Exchange which is a kind of government department store that sells stuff at near cost prices, and as a retiree you continue with the ability to use the exchange. Plus no tax.

    I knew a guy who stayed in as a flight surgeon because he loved to fly jets and flight surgeons can take the second seat on non critical missions. The only way he was going to access jets was to stay in, but he eventually went in the reserves, went into private practice on the outside, and retired an 0-6. I made some really good friends in the service, certainly a different crowd, but very good people.

    I got out after 2 years since they paid for 2 years. It was a hell of a deal. No debt gave me the freedom to chose my next gig NOT under the gun. I did locums, traveled with my wife, lived off the perdeim, Invested the salary and had a blast exploring my locums environment. I tested out many different practice scenarios and finally found my niche’, not because I locum’d there but because I networked into the job. So instead of being $300K in debt I had no debt and $300K in a retirement fund 3 years out of residency plus I wasn’t green. It turned out 2 of the guys I served with wound up working at my hospital a surgeon and an orthopod wound up at my hospital after they got out. My business partner was ex Navy and we had all kinds of ex service docs at my hospital. There is a particular comradary and networking that exists between ex service docs.

    Interesting topic.

    • Thank you for the comment, Gasem. In your case, the math worked out well for you to join, and also to get out early. I think WCI had a similar experience.

      While neither of you stayed in, you still have that military med experience and the comaradarie with others that comes with it. My father enlisted as an Army dentist during Vietnam; he still sees his military buddies regularly some 45 years later.

      Best,
      -PoF

      • Gasem

        My service dentist set up his practice 40 miles from here and he’s still my family’s dentist, awesome dentist. My orthopod buddy who I served with also uses him. I also did some 1099 moonlighting at one of the level 3 trauma hospitals in the city where my base was located. Pretty much everybody in our unit was helping at that hospital. It was pretty easy in the service to adjust our schedules for that, and all of that money went straight into the market. What I wanted to show is there are some more subtle financial aspects beyond the obvious.

  • Ann

    Another consideration is your spouse’s job. It is very hard to develop a career when you are constantly having to move, sometimes to places where there are very limited job options, or overseas. I was single when I was in, and had an amazing experience–I will never again get to do the things I had the opportunity to do in the Navy. My friends who were married to a spouse who wasn’t also active duty had all sorts of issues, especially if the spouse was interested in developing a career. Many ended up divorced, which really cuts into that pension check. Those that didn’t still had less household income due to their spouse not being able to advance in their career.

    I find these types of analyses often are based on if you make all the right financial decisions in both scenarios. My experience is that when people are happier and more secure in their life choices, they tend to make better decisions–when they are not happy they try to buy happiness which doesn’t really work. So the best decision is to do what will make you and your family happiest.

    Happy Veterans Day to everyone!

    • Great points, Ann, and you’re certainly right about divorce being a major financial and personal hardship. I know it can be difficult — you may hope to go to the Florida panhandle, but end up in Minot, ND. I’m not saying there’s anything wrong with Minot, but it’s not necessarily at the top of everyone’s wishlist.

      Best,
      -PoF

  • My wife is a pharmacist with the Public Health Service, a Uniformed Service like the military. Her rank is O-5. They have all the same pay tables and pension as military, but the core difference is that they aren’t considered “armed.”

    Members of the PHS avoid many of the pitfalls of regular military officers. Relocation is optional (but very strongly encouraged for promotion). Deployments are often optional (but even more strongly encouraged for promotion). We can live where we want, but there are limited jobs in the country, so that usually dictates location more than anything else.

    While Tri-Care for Life is cheap, I’m not sure it’s free. I knew it was valuable, but I didn’t think it was worth another 15-18K a year. Veteran benefits are also plentiful such as being able to use the commissary for cheaper food.

    Another thing mentioned in the comments is the GI Bill. That’s huge for sending our kids to college. It’s potentially worth another $200,000 alone.

    What gets really interesting is after you get to 20 years. The pension goes up 2.5% per year after that, WHILE your pay goes up. If my wife were to stay in for 30 years (which is probably doubtful) it is 75% of her base pay which could be $120,000 (assuming she makes O-6). That’s a pension that’s worth $90K, which is substantially worth more than 2.5M presented in the article.

    As Ann mentioned above, my career options are different than most people. It isn’t easy, but I’ve tried to make it work by patching together a bunch of small side gigs (blogging, dog sitting, managing rental properties, etc.).

    • I didn’t know that about your wife — the pension growing at 2.5% per year beyond 20 gives her those golden handcuffs, doesn’t it?

      It sounds like it may only be 2% per year for people coming in now, but it still significantly increases the benefit of working “one more year.”

      Thanks for the info!
      -PoF

  • ENT Doc

    Good article, and always good to revisit. I completely agree with the statement that this is not a financial decision for most people. Does $200k in GI bill benefits make up for missing out on 6 months of my children’s lives? Or being away from my wife? For me the answer is absolutely not. For others it’s worth it. Both answers are fine. Some other things worth incorporating into the financial analysis:
    1. Many states don’t tax the pension but on the flip side they become fixed payments, reducing your ability to game the system with capital gains/qualified dividends 0% tax brackets and Roth conversion ladders. More important for those thinking early retirement.
    2. Lack of ability to own a homed due to frequent moving, or the costs of buying a home and moving more frequently than one might like vs settling down for 20-30 years somewhere building equity in a single home.
    3. Cost sharing with Tricare is increasing and will likely continue to do so.
    4. Military discounts (impossible to really measure but are meaningful)

  • Hi POF!

    1. What about moving from the military to civilian federal service (mainly the VA)? I don’t know about the medical aspects of it, but those jobs are very sought-after among the doctors I know. The pay is relatively high, and there’s no need for malpractice insurance or dealing with health insurance billing.

    2. What about, after the military, supplementing your income by doing medical-legal consulting? (Malpractice cases for either side, and independent medical examinations of people who’ve been hurt in accidents). A first-rate board-certified specialist can charge $600-750 (or more) per hour on the cases they choose to take, and that’s pretty much cash-compensated work (no need to deal with the health insurance system).

    3. From my perspective of a private-sector civilian married to a federal employee (a private-public partnership, if you will), I love it. My wife does not work insane hours, and we get government health insurance (worth about $23k per year, of which the government pays 75%), plus the TSP. She also gets a pension and Social Security.

    • Hey Miguel!

      I spent 9 months as an attending anesthesiologist in the VA health system. There are pros and cons, but you do have the benefit of caring exclusively for veterans, so it could be a great transition for active military. In my experience, the pay is on the low side, but the benefits are good.

      Medicolegal consulting is an option for any physician that has the interest. The pay sounds incredible — much more lucrative than a VA position, certainly, but it’s not something I’ve spent much time looking into.

      Best,
      -PoF

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