JAN-FEB 2019 Trauma Clinical Community Newsletter

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This document contains many opportunities to get involved in trauma, if you are interested:

Trauma CC Newsletter – JAN-FEB 2019

March 2019 Global Health Engagement Professional Development Update

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This has Global Health Engagement updates, including how to request the Additional Qualification Designator (AQD):

GHE Professional Development Update 201903

Guest Post – Full Time Outservice Fellowship Gouge

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By Dustin Schuett, DO (with MCCareer.org editorial comments in italics)

Note: The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.

One of the strongest parts of Navy Graduate Medical Education (GME) is the ability to pursue Full-Time Outservice (FTOS) fellowship training. Being approved for Navy FTOS fellowship training makes you essentially a “free” fellow to whatever program you enroll in as you will continue to receive active duty Navy pay and allowances.

The biggest difficulties of a FTOS fellowship are typically logistical issues associated with being assigned to a ROTC or Reserve Unit Command. (For example, when I did my FTOS fellowship in emergency ultrasound in Delaware, I was assigned to the University of Pennsylvania ROTC unit.)

Here are some of the things I and some colleagues have learned thus far in our FTOS fellowship experiences that I wish I would have known before I started fellowship and even before PCSing from my prior Navy command.

  • Big key: when in doubt, ask. Mark Sullivan at the Navy Medical Corps GME Office is your go-to for any questions/issues. He’s a phenomenal resource who does a great job helping out and keeping you informed leading up to and during your FTOS fellowship. (His contact info can be found on the right hand side of this page.)
  • Look to see if you’re eligible for a retention bonus running concurrently to your fellowship and fellowship payback entitling you to additional money without added payback.
  • If you’re going from an actual Navy command, I strongly recommend taking advance dislocation allowance (DLA, money to partially reimburse a member for the expenses incurred in relocating the household on a PCS)
    • The location of your fellowship is likely not near a major Navy base with normal Navy admin support. Many are assigned to a ROTC unit or Reserve center which may be severely lacking in admin support.
    • I’m currently 8.5 months into waiting for my DLA from PCSing last June and wishing I would have taken advance DLA.
  • Start your state license application process early. Unless your fellowship is in the state where you are already licensed, you will likely need to get licensed in that state. This can take 3-4 months or even longer. For more arduous states like Massachusetts, I would recommend starting the October before you start fellowship. (Normally you can used any state license to practice in the Navy, and this same requirement should apply to FTOS training, but the civilian hospitals almost always want you licensed in the state they’re in. Mine did.)
  • You are still required to complete the Body Composition Assessment (BCA) and the Physical Readiness Test (PRT) because you are still on Active Duty. The opportunity to skip the PRT if you scored an “Excellent Low” average with no event below “Good Low” should still apply, but check with your command.
    • Because you are on Active Duty, even if you are exempt from the PRT, you will still have to pass the BCA within standards.
  • Check-in is extremely variable with some commands having a full orientation day. My NROTC Unit in Boston had us coordinate a time to check in with the civilian administrative assistant. This was approximately a 2 hour process to check in, stop PCS leave, and complete the basic unit transition paperwork. It was very informal and done in civilian attire
  • Command structure varies by area. If you are part of a ROTC unit, you fall under their CO and abide by their rules. Leave is arranged through your command and the rules of when you must be on leave depend on your command. The NROTC Boston rules are if you’re flying or driving more than 300 miles, you have to be on leave. (They will also do your fitreps as well. My reporting senior was a Marine Colonel at the ROTC unit.)
  • Leave is typically performed through NSIPS. On arrival at your new command, see what needs to be done to get you transferred to their NSIPS roster so that you can request leave. Since you’re not actually doing work at the ROTC/Reserve unit, almost any leave will be approved.
    • International leave still has the same rules as at a regular Navy command, so plan in advance for any trips out of the country and engage your Chain of Command early.
  • Access to mail.mil email is variable. My account was disabled by my old command soon after I arrived while a friend doing fellowship across town still can access his email account with his CAC reader. Plan to not have access to your military email during fellowship, so save important emails and email addresses you may need outside of Outlook just in case.
  • Fitreps in FTOS fellowships are almost exclusively non-observed. There are stories of rare commands completing observed Fitreps, but this is not the norm. (I do know someone who was able to contribute to the ROTC command and got a ranked fitrep.) You can still put text into the block 41 narrative detailing your accomplishments during your fellowship to include publications, meeting presentations, obtaining board certification, etc.
    • You will have a non-observed Fitrep when your rank’s normal Fitrep hits (January for LT, October for LCDR, April for CDR) and a non-observed departing Fitrep when you check out. The only exception could be a CAPT in fellowship with potentially just a July regular non-observed Fitrep.
  • Funding for TAD/conferences is usually through your fellowship or out of your own pocket. There may be very limited opportunities to get TAD funded by your local Navy command, but check with your command first. Most commands have no issue with placing you on no-cost TAD or special liberty for trips to conferences/meetings and other travel outside of your leave boundaries required by your training program.
  • You will be on your command’s random urinalysis (UA) roster. Most commands understand that you have a busy and often inflexible schedule. When my name has come up for random UA, I received an email a day or two ahead saying the available times with the opportunity to reply if I could not make those times with the understanding that another time ASAP would need to be worked out.
  • If you will be taking your Board Certification Exam or the final step of your Board Certification Exam soon before reporting or while PCSing, you will be eligible for Board Certification pay once you have been notified of passing. Board certification pay requests are routed through Mark Sullivan at the Medical Corps GME Office in Bethesda. You will need to route an endorsement through your CO at your unit, but the majority of the paperwork and the funding is handled by the GME office.
  • If you are in zone for consideration by a promotion board, being in a FTOS Fellowship does not change this. I highly recommend doing everything you can to prep your record including ensuring all documentation is correct, you have an officer picture, and everything else listed in the Promo Prep document Dr. Schofer has put together 6-12 months BEFORE PCSing from your pre-fellowship command. It is exponentially easier to do this at an actual Navy command than through a reserve/ROTC command. Your access to BUPERS Online (BOL) and other CAC-enabled sites may be limited during your fellowship and most of the time you will be very busy. Getting your record ready 6-12 months before your start fellowship ensures you have plenty of time to correct any discrepancies well in advance of the board.
    • Letters to the board can potentially help your promotion odds. FTOS fellows in the past have had their fellowship program directors write letters to the board detailing their performance in fellowship, some even had the fellowship directors write the letter hitting all of the Fitrep performance traits (Professional Expertise, Command Climate/EO, Military Bearing, etc.) specifically to replicate a Fitrep as closely as possible.
  • Moonlighting is not permitted in any form during FTOS fellowship. Sorry. Your co-fellows may be moonlighting a ton and making more money, but keep in mind they’re likely making around $70,000 from the fellowship while you are making $100,000 plus and potentially close to $200,000 if you’re able to do the retention bonus/fellowship loophole plus untaxed money in the form of Basic Allowances for Housing (BAH) and Subsistence (BAS).
  • Industry/externally funded travel/courses may come up during your fellowship. These are often great opportunities to obtain additional education and training without paying for it. You will need a Proffer letter from the company specifically detailing what is being offered in terms of monetary value in travel, lodging, meals, education etc. You will send this Proffer letter to Mark Sullivan who will also need an email from your fellowship program coordinator/director stating that the training is an integral part of your education and that it is being offered to all fellows and not just because of your affiliation with the DoD.
    • Mark will then forward this on to Navy legal who will reply with any requests for information and usually give you a final decision within a few weeks. The decision will be sent in a Navy standard letter detailing your being allowed to proceed. Often, the company sponsoring your travel will need a copy of this letter for their records.
    • Try to stay as far ahead as possible for this. I had an instance where the entire process was able to be completed and approved in a 2 week period, but ideally a month or more should be allotted. It’s a pretty simple process overall and you do not want to get into an unauthorized commitment situation.
    • My command has allowed me to take special liberty for all of these courses so far which has allowed me to save up leave.
  • Keep in mind that while you’re FTOS, you’re still in the Navy. You may not need to shave/put your hair in a bun every day, but don’t show up for your PRT with a full beard (yes that happened and yes the whole unit got an email from the XO about it).
  • Enjoy the time in fellowship and being as close to a civilian as many of us will have for a 10-20 year stretch of our lives!
  • What other questions do you have about FTOS fellowship? Please leave a comment or email me at djschuettdo < at > gmail < dot >com and I will try to answer any further questions.

What the DoD FY20 Budget Request Says About Military Medicine

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If you want to read a summary of what is in the recently released President’s budget, download this document and search for the word “medicine” or go to page 24 and read the section entitled “Managing the Military Health System”:


$718.3 Billion Defense Budget Request Focuses on Threats

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WASHINGTON — At $718.3 billion, the fiscal year 2020 defense budget request announced at the Pentagon today by defense officials is an increase from last year’s $685 billion approved budget.

This year’s request focuses on addressing peer threats emanating from Russia and China, which are modernizing their forces at an unprecedented rate, according to David L. Norquist, who is performing the duties of deputy defense secretary.

The budget reflects the priorities of the 2018 National Defense Strategy, he continued. Priorities are in the following four areas: investment in the emerging space and cyberspace domains; modernizing capabilities in the air, land and maritime domains; acceleration in technology such as artificial intelligence, hypersonics, autonomy and directed energy; and, sustains the force and builds on readiness gains.

Norquist, Elaine McCusker, DOD’s deputy comptroller, and Army Lt. Gen. Anthony R. Ierardi, director, Force Structure, Resources and Assessment, Joint Staff, conducted a Pentagon news conference today, concerning the 2020 Defense Budget.

Military Pay Raise

McCusker said the budget takes care of service members. “Our force is our most valuable asset.”

It calls for a 3.1 percent military pay increase — the largest in a decade, Norquist noted. The pay increase is for the forecast 2,140,300 members of the active, guard and reserve total force, which is also an end-strength increase of about 8,000 from this fiscal year.

Besides the pay raise, McCusker said the budget reflects efforts to modernize the health care system and care for families with such things as child care and schools.

She noted that DOD is on track to save about $6 billion this fiscal year due to reform efforts in information technology, providing more efficient health care services, smarter customer purchases of goods and services and divestment of programs no longer consistent with the NDS.

Budget Breakdowns

The $718.3 billion budget includes $66.7 billion for overseas contingency operations  and $9.2 billion for emergency operations, which includes hurricane recovery and security for the Southwest border.

The breakdown of the $718.3 billion by appropriation type is: $292.7 billion for operations and maintenance, or 41 percent of the budget; $155.8 billion for military personnel (22 percent); $143.1 billion for procurement (20 percent); $104.3 billion for research, development, testing and evaluation (15 percent); and $22.5 billion for military construction, family housing and other (3 percent).

The breakdown of the $718.3 billion by military department is: $205.6 billion for the Navy, or 29 percent of the budget; $204.8 billion for the Air Force (29 percent); $191.4 billion for the Army (27 percent); and $116.6 billion for defensewide activities (16 percent).

The total national defense budget request is $750 billion. Besides the $718.3 billion for DOD, the remainder goes to the Energy Department and other agencies.

Past approved defense budgets were $606 billion for FY 2017, $670.6 billion for FY 2018 and $685 billion for this fiscal year.

Space Domain

This year’s budget request sets aside $14.1 billion for the space domain, including $72.4 million to resource the new Space Force headquarters, $1.1 billion to mitigate risk to satellite communications jamming, $1.8 billion to increase GPS follow-on satellites and operational control systems, $1.6 billion to improve space-based missile warning capabilities and $1.7 billion for space launch capabilities.

Cyber Domain

If the request is approved, cyber would receive $9.6 billion, of which $3.7 billion would be for offensive and defensive cyberspace operations; $5.4 billion for cybersecurity to reduce risk to DOD networks, systems and information; and $61.9 million to modernize DOD’s multicloud environment.

Air Domain

The request allocates $57.7 billion for the air domain. Notable purchases include $13.9 billion for 110 fourth- and fifth-generation aircraft —  including 78 F-35 Lightning II fighter aircraft, $2.3 billion for 12 KC-46 tankers, $651 million for 389 advanced medium range air-to-air missiles, and $582 million for 430 extended range joint air-to-surface missiles.

Maritime Domain

The request sets aside $34.7 billion for maritime operations, including funding for two new Gerald R. Ford-class nuclear aircraft carriers. Other line items include $447 million for two large unmanned surface vehicles, $209 million for 48 long range anti-ship missiles, $707 million for 90 maritime strike tactical Tomahawk missiles, $10.2 billion for three Virginia-class submarines, $5.8 billion for three Arleigh Burke-class destroyers and $1.3 billion for one multimission guided missile frigate.

Land Domain

The request for funds directed at the land domain totals $14.6 billion, to include $1.6 billion for 4,090 joint light tactical vehicles and $395 million for 56 amphibious combat vehicles. Investments will also go to the purchase of multirole anti-armor weapon systems, binocular night vision devices, squad common optics and squad thermal systems.


The request allocates $13.6 billion to missile-defeat and defense systems, to include $1.7 billion for ground-based missile defenses, $753.8 million for 37 Terminal High Altitude Area Defense systems, $1.7 billion for 3 missiles and 36 installations of Aegis ballistic missile defense systems, $174 million for space-based missile warning and defense demonstrations and ground control enhancements to address hypersonic threats, $331 million to develop boost-phase and advanced technology missile defense systems — to include directed energy and air-launched kinetic interceptors, and $844 million for systems that can destroy adversary ground-based missiles before they launch.

Nuclear Enterprise

The request for funds directed at modernization of the nuclear force totals $14 billion and includes $712 million for long-range standoff weaponry, $3 billion for the B-21 Bomber, $570 million for ground-based strategic deterrent, $2.2 billion for the Columbia-class submarine, and $2.5 billion for enhanced nuclear command, control and communications capabilities.

Special Operations Forces

The $3.4 billion earmarked for special operations forces in the fiscal year 2020 request includes $27.2 million for directed energy weapons, $342.8 million for AC-130J Ghostrider/MC-130J Commando II aircraft, $45.3 million for CV-22 Osprey tiltrotor aircraft and $105.7 million for additional surface and subsurface maritime craft systems.