October Message from ASD(HA)

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MHS Team:

Over the past month, our Military and the Nation has continued to respond and meet the unique challenges presented during the COVID-19 pandemic. The Military Health System (MHS) has been central to this effort in numerous ways, both as an organization and through individual accomplishments.  And while supporting the pandemic response we also have continued to advance an array of other MHS initiatives.  Updates on a few of these efforts include:

MHS GENESIS Go-Live.  The rollout of MHS GENESIS continues to make enormous strides leveraging lessons learned from the previous execution of the Initial Operational Capability sites on the West Coast and Wave Travis. On September 26, 2020, the Nellis Wave went live at the following bases:  Beale AFB, Edwards AFB, Los Angeles AFB, Nellis AFB, Vandenberg AFB, Fort Irwin Army Base, and the United States Marine Corps Air Ground Combat Center. The volume of WAVE Nellis requirements was two times the size of any previous roll out. Leadership at each facility reported no show stoppers and provided positive feedback. Lessons learned from previous sites were instrumental to a seamless release and resulted in a significantly reduced number of initial trouble tickets requiring action. The next deployment will be WAVE Pendleton and the “Go-Live” is 31 October.

National Influenza Vaccine Modernization Strategy (NIVMS). To help ensure we are prepared to address the impacts of seasonal and pandemic influenza viruses, DoD and HHS co-hosted a series of stakeholder listening sessions.  I had the chance to provide a welcome video for those attending these virtual sessions.  This effort is a collaboration among industry, academia and government to support the strategy released 8 June to implement the Executive Order to modernize the flu vaccine and promote national security and public health. Exciting advances will most certainly result from this enlightened collaboration.  We discussed the role of federal and non-federal partners in NIVMS, and solicited feedback and viewpoints from external stakeholders.  I’d like to thank COL Jennifer Kishimori, Director, CBRN Medical Countermeasures Policy of Health Readiness Policy and Oversight in Health Affairs, for representing the Department during this effort. Anything we can do to increase the effectiveness of flu vaccine development and distribution will improve military readiness and capability.

Speaking of the flu vaccine, we are in the beginning of the 2020-21 flu season.  Flu vaccination will help reduce the overall impact of respiratory illnesses on the population and decrease the burden on the health care system during the COVID-19 pandemic.  We encourage all of you to get the flu vaccine. Beneficiaries can also get a flu vaccine at no cost by visiting a TRICARE participating network pharmacy. Visit www.tricare.mil/flu to learn about TRICARE coverage and the flu vaccine.

COVID Convalescent Plasma: At the onset of the pandemic, the DoD developed a convalescent plasma (CCP) collection strategy to ensure we were able to independently support advanced COVID-19 illness within the force. We were charged by the Secretary of Defense to collect 10,000 units by September 30, 2020. Thanks to our dedicated Service members, their families, and our beneficiaries, we exceeded our 10,000 unit goal by collecting 10,745 units by the close of the fiscal year. Critical research continues to study the science on the impact of CCP on moderately and critically ill patients and how the DoD can protect our operational forces with the availability of CCP for use in remote locations.  Thank you to everyone that made this possible, especially those working with COL Audra Taylor in the Armed Services Blood Program. 

AMSUS Update: We are working with AMSUS representatives to support this year’s virtual conference by planning to highlight the MHS pandemic response through participation in the plenary session and breakout presentations.  The conference will occur virtually 6 – 10 December, and the MHS Plenary will be held on 8 December.  We are excited to announce that Deputy Secretary of Defense HON David Norquist and Dr. Matt Hepburn, JPEO CBRN and SME on vaccines for Operation Warp Speed will both be speaking during the plenary.  Please save the date!

Women’s Reproductive Health Survey: The DoD Women’s Reproductive Health Survey is available for female active-duty Service members. The survey assesses reproductive health and well-being and examines behaviors and experiences that may impact readiness. The survey is voluntary, confidential and .anonymous and takes about 15 minutes. Participation is by invitation only, so if you were invited to participation please take a few minutes to complete this important assessment. The results will be used to improve policies, programs and services. This is the first time in nearly 30 years that a DoD-wide study of only female service members’ experiences has been completed. Some service members may have seen some of these questions on other surveys in the past. But because those studies were of limited groups of women, and because of confidentiality protections, that information cannot be used to provide a complete picture of service women’s experiences, reproductive health and well-being. Please visit the site before 3 November and use your military email to determine your eligibility to participate: https://dodwomenshealth.com.

National Physician Assistant’s (PA) Week. The US Military played a critical role in the development of the PA profession.  The vision of Dr. Eugene Stead Jr, a doctor who served in WWII, to solve a growing shortage of primary care providers in the 1960’s led to the launch of the profession.  The first graduating PA class, created at Duke University in 1967, consisted of three former US Navy corpsmen.  I had the opportunity to visit the Fort Belvoir Community Hospital to celebrate National PA Week and personally thank the 14 PA’s assigned to the hospital and recognize all active duty, reserve, civil service and contractor PAs serving our military, their dependents, and all beneficiaries.  Thank you to CAPT Cynthia Judy, Director of FBCH and CAPT Saira Aslam, Chief of Staff of FBCH, and their incredible staff for their hospitality in giving me a chance to highlight the remarkable work of our amazing MHS corps of PAs.


On 15 October, during a Health Affairs Town Hall, I had the honor to present the Secretary of Defense Medal for Meritorious Civilian Service to Dr. Mark A. Hamilton, recognizing his exceptional leadership, invaluable contributions, and extraordinary performance across the MHS as Health System Transformation Office, Chief of Staff, for the Office of the Assistant Secretary of Defense for Health Affairs from October 2017 until October 2019.  Well done, Dr. Hamilton!   

COL(Ret)/Dr. Paul Pasquina, Professor and Chair of the Department of Physical Medicine & Rehabilitation (PM&R) at the Uniformed Services University of the Health Sciences, is the 2020 recipient of the AMSUS Lifetime Achievement Award.  Congratulations Dr. Pasquina!

As we head into the final weeks of 2020, I want to say how proud I am of this remarkable team and all we have accomplished together, especially amidst the challenges faced operating in a Covid-19 environment.  Thanks for all you do for the Military Health System and those we serve.


Change in Catch-Up TSP Contributions and Finance Friday Articles

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Here’s a cut/paste from the TSP announcement about a change for catch-up contributions:

Catch-up contributions will soon get easier

Starting in January 2021, we will make the catch-up process easier: if you’re turning 50 or older, you’ll no longer need to make two separate elections each year in order to take advantage of catch-up contributions.

Instead, your contributions will automatically count toward the IRS catch-up limit if you meet the elective deferral limit and keep saving. If you’re eligible for an agency or service match, contributions spilling over toward the catch-up limit will qualify for the match on up to 5% of your salary. Your election will carry over each year unless you submit a new election.

For 2020 catch-up contributions, you do still need to complete the current process and make a separate election. Check current contribution limits to make sure you’re on track this year.

Here are this week’s articles:

Throwback Thursday Classic Post – You Made CDR! Now What?

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If you are one of the lucky people who made CDR, I have some things for you to consider:

  • The next 2-3 years of fitreps may mean very little to your overall career.  First, you are soon going to be in the most competitive group in the Medical Corps, Commanders scratching and clawing to make Captain.  If you are at a medium to large command, no matter what you do as a junior Commander, you are likely to get a P (promotable) on your fitreps.  That is just how it works for most commands.
  • This first bullet means that now is the PERFECT time to do something “alternative” (off the usual career path for a physician) or take a position that you know will get you 1/1 fitreps or be part of a very small competitive group.  Go to the War College.  Take a senior operational job where you’ll get a 1/1 fitrep.  Become a Detailer.  Apply for fellowship because the NOB fitreps won’t hurt you as a junior Commander or Commander Select.  Now is the time to do these type of things.  You don’t want to wait until you are a few years below zone for Captain.  When you reach this stage you’ll need competitive EP fitreps.
  • After you are selected for your next rank is also a great time to move/PCS.  Have you ever been OCONUS?  If not, now would be a great time to go.  You can PCS somewhere for 2-3 years and then PCS to the command where you are going to set up shop and try to make Captain.  At OCONUS commands there is more turnover of staff, so major leadership jobs like MEC President, Department Head, and Director positions open up more frequently, setting you up to get a senior position when you return to CONUS.
  • You may think I’m crazy, but it is time to start thinking about how you are going to make Captain.  As I mentioned in the first bullet, getting a job that will make you a Captain is tough and competitive.  Now is the time to do the things that will make you an excellent candidate for one of those jobs.  Want to be a Residency Director?  Maybe you should get a degree in adult or medical education.  Want to be a Director?  Maybe you should get a management degree like a Masters in Medical Management or an MBA.  Want to be a senior operational leader?  Now is the time to do Joint Professional Military Education I and/or II.
  • Here is a list of the jobs that I think will likely make you a Captain.  Read the list…figure out which of these jobs you are going to use to make Captain…and get busy preparing yourself to get them:
    • Residency Director
    • Department Head in a large MTF
    • Director
    • Chief Medical Officer
    • Officer-in-Charge
    • Major committee chair
    • Medical Executive Committee President
    • BUMED staff
    • Specialty Leader
    • Deployment requiring an O-5 or O-6
    • Detailer
    • Senior operational leader
      • Division/Group/Wing Surgeon
      • CATF Surgeon
      • Amphib or CVN Senior Medical Officer

Optimally you’ll have the time when you are an O5 to do multiple jobs on the preceding list.  For example, as an O5 I had been a Detailer, a Specialty Leader, Department Head, Associate Director, and CO of a deployed unit.  My next step was to become a Director at a major MTF, and while I was a senior LCDR and CDR I obtained a Naval Postgraduate School MBA as well as achieved certification as a Certified Physician Executive to try and make myself a competitive candidate for a Director position. Ultimately, I became the Director for Healthcare Business at NMC Portsmouth.

Congratulations on making Commander…take a deep breath…and start thinking about some of the things I mentioned in this post.  Before you know it you’ll be in zone for Captain.

What is an Expense Ratio?

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Whether you are managing your investments by yourself or getting help, you need to understand one critical concept, the expense ratio of your investments. Every mutual fund and exchange-traded fund (ETF) that you invest in has an expense ratio, and keeping it as low as possible is key to your long-term financial success.

What is an expense ratio? An expense ratio is the percentage of a fund’s assets that is used for expenses. In other words, if you invest in a mutual fund with a 1% expense ratio and that fund makes 10% in 2020, you’ll only get a 9% return on your investment because 1% goes to pay expenses. The less of your return you use to pay expenses, the more you get to keep.

What is an average expense ratio? An average stock mutual fund has an expense ratio of 0.6% in 2019, but the expense ratios for mutual funds that are similar in their composition can vary wildly. For example, if you look at a list of Standard & Poor 500 index funds offered by investment companies, you’d find expense ratios as low as 0.04% (like the TSP C Fund) and as high as 2.43% (ticker RYSYX). While 2.39% does not seem like that large of a difference, keep in mind that costs last forever and that small differences compounded over years will cost you a lot of money.

Let’s pretend that when you are 25 years old your grandparents give you $10,000 to invest in an S&P 500 index fund for 50 years, during which you earn a 9.5% return. If you invested in an average mutual fund with a 0.6% expense ratio, you would have $683K. If you invested in the Vanguard index fund (another low cost S&P 500 index fund like the TSP C Fund) with a 0.05% expense ratio, you would have $902K. That 0.55% difference in the expense ratios cost you $219K! Small differences in expenses can make huge differences in long-term investment returns, so you need to pay attention to the expense ratios of your investments.

This difference is even more dramatic when you compare actively managed funds to passively managed index funds. Because actively managed funds have higher expense ratios than index funds, it is very difficult for an active manager to beat his/her comparative index over the long-term. This is why I invest 100% in index funds.

When you are picking your investments, keep in mind that you can’t control what happens to the market, but you can control which investments you choose and the expenses that they charge. Any time you are looking to invest in a mutual fund or ETF, you should search for similar funds and compare expense ratios, which you should try to keep below 0.5% (or even 0.25% if possible). Make sure that at a minimum you take a look at the Vanguard version of the investment you are considering since their expense ratios are among the lowest in the industry and they never charge extraneous fees, like loads. There is no reason to pay more expenses for what is essentially the same investment product. It could cost you A TON of money over the long-term.

USU Faculty Development Fall 2020 Newsletter

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Here’s the newsletter, which includes the info on how to get a faculty appointment:

Election 2020: What Servicemembers Can and Can’t Do

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Here’s a link to this article from MOAA:

Election 2020: What Servicemembers Can and Can’t Do

Here’s a summary from BUMED:

As we are in the middle of an election cycle, your BUMED Ethics Counselors wanted to ensure all hands have the most recent guidance concerning political activities.  We encourage you to read the attached information, which includes guidance applicable to telework. 

General reminders:

While teleworking, employees are on duty.  Therefore, employees may not use their personal computer or personal mobile phone to participate in political activity, including sharing a partisan political party message or re-tweeting an endorsement of a political candidate. 

Employees are prohibited from using Government-issued office equipment, email, and internet at any time for the purpose of engaging in political activities.

Active duty military members and further restricted civilian employees are prohibited from participating in partisan political activity.  These employees may “follow” or “like” a political party or candidate running for partisan office, but they may not post links to, “share”, or “re-tweet” comments from a candidate’s or political party’s Facebook page or Twitter account, as such activity is deemed to constitute participation in political activities.

Service members must also be careful not to comment, post, or link to material that violates the UCMJ or Service regulations.  For example, showing contempt for public officials or posting unprofessional material that is prejudicial to good order and discipline. 

Please see the attached guidance for more information and examples of permissible and prohibited activities:

Finance Friday Articles

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It takes a LONG TIME to compile all the articles for Finance Friday, and not that many people click on them, so I’m going to just start listing my favorites instead of my favorites plus the rest of the articles. Here are my favorites this week: