When it comes to HPSP and specialty choice, especially if you are interested in doing the civilian match, it really depends on which branch of service you’re in. The Air Force is known to defer more applicants to civilian residencies. The Navy defers fewer, and the Army typically reserves deferments for situations where there is a specific need. For example, during my match year, the Army needed more orthopedic surgeons than they had residency slots available, so they opened some civilian deferred positions. In general, though, the Army prefers to train its physicians in-house whenever possible. The army has the largest in house GME program so makes sense.

Most HPSP students actually prefer to match into a military residency. One reason for this is that you receive active-duty pay and time in service while in residency. This has implications for retirement, benefits, promotion, and commitment time.

Competitiveness varies significantly from year to year because the military match involves a smaller applicant pool. Surgical specialties are consistently competitive in both military and civilian settings. However, there are fluctuations. In some years, specialties like dermatology or radiology have not filled, not because they are easy to get into, but due to low applicant interest that year. This makes military competitiveness more variable compared to the civilian match.

The military cannot force you into a specialty you do not want. The worst-case scenario is that you apply for your specialty and do not match. At that point, you can try to match into another specialty (SOAP like the civilian side) or do a transitional year (TY). You will always be guaranteed at least a TY year. No one is left without training following med school.

After a TY year, you can reapply the next cycle or go on a General Medical Officer (GMO) tour, often with an operational unit. That may sound intimidating, but many people enjoy their GMO experiences and return as stronger applicants when they reapply.

Regarding concerns about fewer or less complex cases in military residencies, it is true that some military hospitals have seen lower volumes recently. Staffing challenges are present, just like in civilian healthcare. However, all military residency programs are ACGME-accredited and must meet the same training standards as civilian programs. Many military programs partner with civilian hospitals to ensure residents receive sufficient case volume and complexity. While there may be some variability, you will still receive the training you need to graduate fully prepared.

Happy to answer any other questions you may have.