how can i start off as a Sergeant Health Care Specialist (68w)?

All promotions are by time in grade, time in service and your personal record. Once you make E-4 you need to start looking at promotion points for E-5. Weapons qual, APFT, Civilian and Military education and the list goes on. Once you are boarded then your points are calculated and from there it is a matter waiting to see if your points either meet or exceed the promotion points published that month. If you are going in as an E-1 you will have plenty of time and plenty of people to ask and help work with you to get to your goal but it isnt going to happen in the first six months or year that you are in as it takes time to move up. You can fast track but that still takes time and by the time you do make E-5, hopefully you will have enough personal experience and leadership skills acquired so you can wear that rank and actually do the job because right now, I don't believe you are enough close to being aware of how much responsibility being an E-5 and up involves. You have to successfully complete PLDC too to keep it on your collar. That and if you are enlisted, you will always be the "little man" in an odd way. You can be an E-6 but you still have to answer to an E-7, an E-8 First Sergeant, an O-1 Lieutenant, an O-3 Captain, a Ltc and so forth. Pursue your education, but you will soon find out that making rank takes competence and TIME.

Here is how I fast tracked to Sergeant in 2.5 years. Got bachelors degree and joined Army as E-4, deployed with my unit to Iraq as an E-4. Performed well in combat and got promoted to Corporal, got placed in a Sergeants job and did well in that job earning a medal for valor. Then I promoted to Sergeant. As others are saying, being a Sergeant means something and comes with a lot of responsibility. Sergeants aren't and shouldn't be people who really don't know what they are doing. It is however an excellent challenge and if you try hard and do well then you can make a good Sergeant with just a couple of years in the service.

You are not going to start as a sergeant. You have to earn it like everyone else. You can go in as an E3 if you have enough college credits.

Then you still have to wait for time in service and time in grade. You will make rank as long as you do your job well and stay out of trouble.

It takes time and experience. "Sergeant" isn't just a title/paygrade. It's responsibility and quite frankly, you don't need to rush into it because you'll just get someone killed.

Be patient, train hard, study hard, PT hard and it will come in no time.