The submitted paper (revision 16) answers a narrower and longer question than this brief first set out. This amendment records that change; the original brief below is kept unchanged so the history shows how the question moved.
paper/appendix_calculations.py reproduces every figure in Appendices B–E from these assumptions.Requested by the instructor’s October 2 review (PR #6). Drafted with AI from the paper’s own text at the author’s request; the author should confirm the wording.
Navy Medicine must retain experienced physicians after their initial service obligations end. Losing physicians can leave clinical positions unfilled and weaken continuity of care and readiness. GAO’s 2025 staffing review reports a decline in assigned military medical personnel across DOD and expected shortfalls through at least 2027. That is current DOD-wide context, not a measured San Diego Navy primary-care attrition rate. The question here is how much financial compensation Navy pediatricians, general internists, and family physicians forgo by staying rather than pursuing a feasible civilian alternative.
The global challenge is sustaining the medical workforce that supports U.S. naval operations in the Pacific. Naval Medical Forces Pacific is headquartered in San Diego and spans commands in Hawaii, Japan, and Guam; its mission includes keeping assigned medical forces staffed, trained, and ready to deploy. San Diego is the local labor-market case for this larger workforce question. This project estimates the financial difference between career paths; it does not establish a retention response or show that departures among these three specialties have reduced Pacific readiness.
What is the financial opportunity cost of continued Navy service for family medicine, internal medicine, and pediatrics physicians over the next four years? The paper’s primary contribution is a transparent calculation for the U.S. Navy Medical Corps. Larger retention bonuses, targeted advertising of existing nonfinancial benefits, and shifting appropriate primary-care work toward nurse practitioners and physician assistants are possible applications of the findings, not predetermined recommendations.
The economic concepts are opportunity cost, marginal choice, and choice among financial and nonfinancial job attributes. The full financial comparison is the present value of a feasible civilian path minus continued Navy service over the same horizon. The current paper calculates only a gross-cash gap, so it is a partial estimate of financial opportunity cost. It does not price personal preferences or forecast retention.
The current paper uses a documented O-4 general-internist scenario just past 10 years of service, with dependents at San Diego ZIP 92134, against Marit’s published $459,057 all-employer internist benchmark. Itemized Navy cash is $276,965.76 in years 1–2 and $282,585.36 in years 3–4, conditional on the stated pay eligibility and $48,000 annual RB agreement. All current base-case calculations use 5% real discounting with year-end payments. The four-year PV cash gap is $636,208.84; taxes, pension, and other benefit differences are excluded. The old $239,000 O-5 inputs are superseded. The local benchmark is not a matched civilian offer, and BAH and the Navy agreement still require final verification.
Frank et al.’s Principles of Economics (4th ed., 2019) makes the course link more precise: the next agreement is a marginal choice, so compare future consequences and exclude sunk training costs (pp. 5–8); the labor market responds to wages and alternatives, but a gap alone cannot reveal a retention elasticity (pp. 73–80, 376–385); and future pay and pension must be put in consistent real dollars before comparing them (pp. 324, 407–414). The course economics crosswalk shows how the textbook applies to the project.
The proposed chain is: local civilian alternatives affect a physician’s stay-or-leave choice; those choices may affect Navy medical staffing; staffing may affect the force’s ability to provide care and deploy. The model measures only the first link. Testing later links requires specialty-level vacancies, fill times, clinical capacity, deployability, and assignment data rather than assuming a pay gap is a readiness loss.
Recalculate each annual gap and discounted total independently. Check the Navy total against an explicit profile and eligible pay components, and check each civilian alternative for specialty, location, hours, practice setting, benefits, and actual feasibility. Test alternative salaries and discount rates. A claim that staying has a financial disadvantage would be weakened or reversed if a comparable alternative and the complete incremental benefits-and-costs comparison eliminated the gap.
The calculation does not test whether bonuses or advertising improve retention. Those are subsequent evaluation questions. Bonus evaluation requires incremental spending, eligible physicians, uptake, and additional physicians retained. Targeted communication should describe real, accessible opportunities; improved awareness without improved acceptance or subsequent retention would not establish a retention benefit. Both approaches need credible comparison groups and attention to career stage and concurrent policy changes.
Start with a limited social-media and advertising campaign about accessible nonfinancial Navy opportunities. Its presumed lower cost and ease of implementation are hypotheses, not established comparative findings. Evaluate accurate awareness, access to advertised opportunities, agreement acceptance, and actual retention against standard communication. Stop or revise a campaign that changes awareness without changing relevant outcomes.