Author: Joel Schofer, MD, MBA, CPE

Throwback Thursday Classic Post – Tips to Get Selected for GME

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I’ve participated in the last four Graduate Medical Education Selection Boards (GMESBs) and would like to offer tips for people looking to match for GME in the future.  We’ll cover general tips and those specific for internship and residency/fellowship:

General Tips

  • Money is getting tight for permanent change of station (PCS) moves at BUPERS.  I think you can increase your chances of matching in GME by being local, or at least on the same coast, as the GME program where you want to train.  Keep this in mind when you are picking your Flight Surgery (FS), Undersea Medical Officer (UMO), General Medical Officer (GMO), or post-residency assignments.
  • If you want to give yourself the best chance of matching, you need multiple peer-reviewed publications.  Any publications or scholarly activity have the chance to help, but having multiple peer-reviewed publications is the goal you should be trying to reach.  Anything that is peer-reviewed counts, including case studies in Military Medicine which are, in general, pretty easy to get accepted for publication.
  • Be realistic about your chances of matching.  If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty.  There are some specialties where you can overcome a major blight on your record, but there are some where you can’t.  If this is applicable to you, the residency director or specialty leader should be able to give you some idea of your chances.  Will they be honest and direct with you?  I’m not sure, but it can’t hurt to ask.
  • If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian.  By the time you pay back your commitment to the Navy, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student.  You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles.

Tips for Medical Students Applying for Internship

  • Do everything you can to do a rotation with the GME program you want to match at.  You want them to know who you are.
  • When you are applying for internship, make sure your 2nd choice is not a popular internship (Emergency Medicine, Orthopedics, etc.).  If you don’t match in your 1st choice and your 2nd choice is a popular internship, then it will likely have filled during the initial match.  This means you get put in the “intern scramble” and you’ll likely wind up in an internship you didn’t even list on your application.
  • Your backup plan if you don’t match should be an alternative program at the same site where you eventually want to match for residency.  For example, in my specialty (Emergency Medicine or EM) we only have residencies at NMCP and NMCSD.  If someone doesn’t match for an EM internship at NMCP or NMCSD, they will have a better chance of eventually matching for EM residency if they do an internship locally, like a transitional internship.  Internships at Walter Reed or any other hospital without an EM program are quality programs, but it is much easier to pledge the fraternity if you are physically present and can get to know people, attending conferences and journal clubs when you can.
  • You need to think about what you will do in your worst-case scenario, a 1-year civilian deferment for internship. Many of the medical students I interview do not have a plan if they get a 1-year deferment.  I think every medical student needs to do one of two things.  Either they should pick 10-15 civilian transitional year internships (or whatever internship they want) and apply to those just in case they get a 1-year deferment, or they should just plan to apply to internships late or scramble if this unlikely event happens to you.  Most medical students do not grasp the concept that this could happen to them and have no plan to deal with it if it does.  It is an unlikely event, especially if you are a strong applicant, and you can always just scramble at the last minute, but this is an issue that every medical student should think through.  If you are going to just scramble at the last minute, that is fine, but it should be an informed choice.

Tips for Officers Applying for Residency or Fellowship

  • You should show up whenever you can for conferences and journal clubs.  Again, you want them to know who you are and by attending these events when you can you demonstrate your commitment to the specialty and their program.
  • Always get a warfare device (if one is available) during your FS, UMO, or GMO tour.  Not having it is a red flag.

PCS Move Improvements

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I know no one wants to read a NAVADMIN, but this one details some pretty good changes for those PCSing:

UNCLASSIFIED//

ROUTINE

R 171240Z JUL 19

FM CNO WASHINGTON DC

TO NAVADMIN

INFO CNO WASHINGTON DC

BT
UNCLAS

NAVADMIN 161/19

PASS TO OFFICE CODES:
FM CNO WASHINGTON DC//N1//
INFO CNO WASHINGTON DC//N1//

MSGID/GENADMIN/CNO WASHINGTON DC/N1/JUL//

SUBJ/PERMANENT CHANGE OF STATION MOVE IMPROVEMENTS//

RMKS/1.  This NAVADMIN provides Sailors and their families with information 
to assist in planning and executing their Permanent Change of Station (PCS) 
moves and provides information regarding upcoming improvements to the PCS 
process and introduction of new tools.

2.  Sailors can reduce out-of-pocket expenses during a PCS move by taking 
advantage of the travel entitlements available to them in advance of their 
move.  Travel advances are designed to assist Sailors with PCS travel 
expenses.  This includes funding assistance for mileage, meals and lodging.  
If you are about to make a PCS move, talk to your Command Pay and Personnel 
Administrator (CPPA) to help you decide if a travel advance is the right 
thing for you and your family.  Special consideration should be given to 
those moving to an overseas duty station or to a location with a higher than 
average cost of living.

3.  Spouse Licensure Reimbursement allows spouses to have certain employment 
licenses or certification costs reimbursed up to $500 when necessary as a 
result of a PCS move.  See NAVADMIN 134/19 for more information.

4.  Additional PCS move improvements are coming in three phases:
    a.  Phase One (July 2019).
        (1) MyPCS Mobile is a mobile-enabled website accessible on personal 
and work mobile devices, tablets, laptops and desktops.
Available now, this tool provides additional flexibility and access to a 
personalized checklist tailored for an individual Sailors PCS move as well as 
the ability to opt-in and immediately get on the waitlist for government 
housing and childcare services at their new duty station for those Sailors 
under Active Duty PCS orders.
Sailors can generate their checklist online at any time and tasks are listed 
chronologically to improve the overall experience for Sailors and their 
dependents.  If a Sailor does not have a set of Active Duty PCS orders 
presently, they can still explore the functionality of the checklist through 
an on-line demonstration of the capability on MyPCS Mobile.
        (2) Sailors will be able to login to MyPCS Mobile at any time through 
the Navy App Locker at https://www.applocker.navy.mil or MyNavy Portal (MNP) 
website at https://my.navy.mil.  MNP will have quick links available on the 
homepage Sailors can use to login to MyPCS Mobile and save the website as a 
favorite on the browser of their choice.  By downloading the Navy App Locker 
for either Android or Apple devices, Sailors can quickly access the MyPCS 
Mobile and other Navy-sponsored content.  Sailors can access the MyPCS Mobile 
website without a Common Access Card (CAC), using commercial grade Multi-
Factor Authentication (MFA) credentials for security.
        (3) To set up CAC-free access, log into MNP on a CAC-enabled machine.  
Your name should appear at the top of the page.  Click on your name, select 
my account, then select the instructions for CAC- free setup.  Follow the 
steps for either Apple iOS or Google Android to authenticate your identity 
under the instructions tab.  NOTE:
This is a one-time event and allows the user to establish their secure MFA 
account to log into the CAC-less applications or websites.  The mobile device 
of the user must have access to either WiFi or cellular data services to 
complete the process.
        (4) PCS Entitlements Calculator is a tool to assist Sailors budget 
for travel-related PCS expenses and it will be available on MNP with a 
release date outlined in an upcoming NAVADMIN.
    b.  Phase Two (August 2019)
        (1) A new format for PCS orders called lean orders will be released 
in early August and available in MyPCS Mobile and on MNP for Sailors on 
Active Duty PCS orders.  This is a streamlined, simplified and plain language 
orders format, providing Sailors and their families everything they need to 
know to execute a move on a few screens on a mobile device.  The full text 
orders will also be available.
        (2) In early August, some Sailors who have a government travel charge 
card (GTCC) will have the option to participate in a pilot program to use the 
GTCC for all PCS related travel expenses (in lieu of obtaining a travel 
advance).  Specifics on this new option will be outlined in an upcoming 
NAVADMIN.
    c.  Phase Three (September 2019).  Sailors will be able to complete a 
fully electronic travel voucher using MyPCS Mobile on their mobile device.  
Sailors will be able to upload receipts, complete a voucher that has been 
prepopulated with basic information, electronically sign and provide it to 
their CPPA for final processing.

5.  These initiatives are just the beginning to Navy fielding a modernized 
PCS move process that makes the overall customer experience better for 
Sailors and their families.

6.  Contact MyNavy Career Center at 833-330-MNCC/6622 or via e-mail at 
askMNCC(at)navy.mil with any issues or to provide feedback.

7.  Released by Vice Admiral John B. Nowell, Jr, N1.//

BT
#0001
NNNN
UNCLASSIFIED//

Throwback Thursday Classic Post – What Should You Do If You Didn’t Promote?

Posted on Updated on

If you are particularly interested in this post, I’m sorry. You or someone you care about probably failed to promote. In reality, nowadays it is normal and expected to fail to promote to O5 and O6, so you have company. Here are my suggestions for those that fail to promote.

First, try to figure out why you didn’t promote. Because the promotion board members are not allowed to speak about your board, you’ll never actually find out why you failed to promote, but you can usually take a pretty educated guess if you talk to the right people (like me).

If any of these things happened to you, they are likely a main reason you didn’t promote:

  • Any PFA/BCA failures.
  • Legal issues, such as a DUI or any other legal trouble.
  • Failure to become board certified.

There are other things that could happen to you that make it difficult but not impossible to promote. They include:

  • Coming into zone while in you were in GME.
  • Having non-observed (NOB) fitreps before the board, such as those in full-time outservice training.
  • Spending too much time in the fleet as a GMO, Flight Surgeon, or UMO. This is mostly because it causes you to come into zone for O5 while you are still in GME, and is more of a problem if your residency is long.
  • Never getting a competitive early promote (EP) fitrep. Many officers who fail to select have never had a competitive EP fitrep in their current rank. This can be because they were stationed places without competitive groups and they get 1/1 fitreps, or it can be because they were in a competitive group and did not break out and get an EP. To me this is the #1 ingredient to promote…competitive EP fitreps. If you don’t have them, you are really up against it.
  • Receiving potentially adverse fitreps. This most commonly happens when you are at an operational command and your reporting senior is not someone who is used to ranking Medical Corps officers, although it could happen for other reasons (like your reporting senior felt you deserved this type of fitrep). The most common situation would be if there is a competitive group of 2 officers but both are given must promote (MP) fitreps instead of 1 getting an EP and the other the MP. When both get an MP, it reflects poorly on both officers unless the reason for this is CLEARLY explained in the fitrep narrative, which it often is not. The other thing that happens is that a reporting senior gives you a 1/1 MP instead of a 1/1 EP. If you are ever getting a 1/1 fitrep, make sure you get an EP. You should consider getting a 1/1 MP an adverse fitrep. If there is no way around this, often because the reporting senior has a policy that they don’t give newly promoted officers an EP, make sure that this policy is clear in the fitrep narrative.
  • Having a declining fitrep. Mostly this happens when you go from getting an EP to an MP on your fitrep under the same reporting senior. If it is because you changed competitive groups, like you went from being a resident to a staff physician, that is understandable and not a negative. If you didn’t change competitive groups, though, make sure the reason you declined is explained.
  • Making it obvious to the promotion board that you didn’t update your record. The most obvious ways a promotion board will know you didn’t update your record is if your Officer Summary Record (OSR) is missing degrees that you obviously have (like your MD or DO) or if many of the sections of your OSR are either completely blank or required updating by the board recorders. Remember that although promotion board recorders will correct your record for you, anything they do and any corrections they make are annotated to the board. While a few corrections are OK, you don’t want a blank record that the recorders had to fill in. It demonstrates that you didn’t update your record.

So who actually promotes to O5 and O6? In general, the officer who promotes is:

  • Board certified.
  • Has a demonstrated history of excellence as an officer. In other words, whenever they are in a competitive group, they successfully break out and get an EP fitrep. Being average is just not good enough anymore.
  • They have no PFA failures, legal problems, declining fitreps, or potentially adverse fitreps.
  • They have updated their record, and if they previously failed to select they reviewed their record with their Detailer and actively worked to improve it.

So what do you do if you were passed over and failed to promote?

Realize that it is not the end of the world. Based on the recent promotion board statistics (which you can get in the Promo Prep), most officers were passed over for O5 or O6, but a large number of the officers selected were from the above zone group.

If you do nothing, you will continue to get looked at by promotion boards until you retire, resign, or are forced out of the Navy. There is no limit to the number of chances you get to promote and your record will be evaluated for promotion every year. That said…

You need to try to promote. Consider sending a letter to the promotion board. What do you say in this letter? First, briefly state that you want to be promoted and to continue your career in the Navy. Second, explain what a promotion would allow you to do that you can’t do at your current rank. Answer the question, “Why should they promote you?”

For example, if you want to be a Department Head at a large military treatment facility (MTF) or a Residency Director (or whatever you want to do), tell them that you need to be promoted to be competitive for these jobs. The Navy wants to promote leaders. Make it clear to them that you are a motivated future leader.

Try and get letters of support to attach to your letter. These letters should be from the most senior officers who can personally attest to your value to the Navy. In other words, it is probably better to get a letter from an O6 who knows you well than a 3 star who doesn’t. If you are not sure who to ask for letters, ask those more senior to you or your Detailer for advice. Your Specialty Leader is always someone to consider if he/she knows you well and can speak to your contributions to the specialty and Navy.

Have your record reviewed by your Detailer, Specialty Leader, other trusted senior advisor, or by me. Because of promotion board confidentiality, you will never know the reason(s) you did not promote, but most of the time experienced reviewers can come up with an educated guess. They’ll often find things that you were not even aware of, like potentially adverse fitreps, or information missing from your record. My promo prep document will help you as well.

Do everything you can to get “early promote” or “EP” fitreps. This is largely accomplished by continually striving for positions of increased leadership. You need to get a job that has historically led to a promotion.

As a LCDR who got passed over for CDR, try to get one of these jobs and excel at it (this list is not exhaustive and these positions are not the only path to CDR, but they are a good start):

  • Assistant/Associate Residency Director
  • Department Head at a small/medium sized MTF
  • Senior Medical Officer or Medical Director
  • Chair of a hospital committee
  • MEC member

If you are a CDR who got passed over for CAPT, try to get one of these jobs and excel at it:

  • Residency Director
  • Department Head in a large MTF
  • Associate Director or Director
  • Officer-in-Charge (OIC)
  • MEC President
  • Division, Group, or Wing Surgeon
  • CATF Surgeon
  • Specialty Leader
  • Chief Medical Officer (CMO)

Meet with your chain-of-command. After you’ve been passed over is not the time to be passive. You need to sit down with your leadership and get an honest assessment from them of how you’re doing and what they would recommend continuing to advance your career. You may not like what you hear, but it is better to find out early if they don’t think you’re doing a good job or that you are unlikely to break out on your fitreps. That way you can try and put yourself in a better situation by changing commands.

In addition to the above list of things you should do, there are a few things you should not do:

  • Do not lie in your letter to the board. In other words, don’t tell them you want to do Executive Medicine if you don’t really want to. Your record reads like a book, and if it tells a story that is contrary to what your letter says, this is unlikely to help you and may hurt you.
  • Do not send long correspondence. Promotion boards have to read everything sent to them, and a long letter may not be appreciated. Keep it brief and to the point.
  • Do not ask your current CO to write you a letter to the board if they’ve done an observed fitrep on you. His or her opinion about you should be reflected on that fitrep, so they don’t need to write you a letter. If they’ve never given you an observed fitrep or there is some new information not reflected on prior fitreps, they could either write you a letter or give you a special fitrep. Ultimately it is up to them whether they do either of these or none.
  • Do not discuss anything adverse unless you want the board to notice and discuss it. This issue comes up frequently and people will ask me for advice, but ultimately it is up to the individual officer. The one thing I can guarantee is that if you send a letter to the board and discuss something adverse, they will notice it because they will read your letter! If you think there is a chance the adverse matter will get overlooked, it is probably better not to mention it and keep your fingers crossed.

Those are my tips for those who find themselves above zone. Most importantly, if you want to promote, NEVER STOP TRYING. You can usually stay in as a LCDR for 20 years, and I personally know of people who got promoted their 9th look!

Fully Funded Occupational and Environmental Medicine Fundamentals Course – Portsmouth, VA – 9-13 SEPT 2019

Posted on Updated on

The Navy and Marine Corps Public Health Center OEM Division is excited to announce the next offering of the Occupational and Environmental Medicine Fundamentals course September 9-13 2019 in Portsmouth, VA!

The course is intended for physicians, physician assistants, and nurse practitioners that do not have formal Occupational Medicine training (i.e. Occupational Medicine residency or experience) who will be practicing in an Occupational Medicine clinic or have significant Occupational Medicine-related workload. The course will cover history of Occupational Medicine, workplace hazards, risk communication, Navy Occupational Health programs, worksite visits, available resources, and will include clinical case break-out sessions.

Non-local students will be FULLY FUNDED BY NMCPHC for travel. There is no fee for the course itself.

We are applying for CME/CNE and anticipate the course will be approved for 31 credit hours as it has been in the past.

NMCPHC will coordinate with the Regional Program Managers & OEM Specialty Leader to ensure course seats are given to those according to clinic needs, responsibilities, and assigned job requirements.

Please visit the NMCPHC Occupational Medicine Fundamentals Course webpage
for more detailed information and student registration request:

http://www.med.navy.mil/sites/nmcphc/occupational-and-environmental-medicine
/Pages/OEM-Fundamentals-Course.aspx

For future planning purposes, we will be offering 2 OEM Fundamentals courses in FY20- dates TBD.

(Also, there will be an Occupational Health Nurse (OHN) Fundamentals Course in FY20- date TBD)

Please read the above webpage carefully to answer your questions.

Senior O5/O6 Position in Medical Inspector General Office – Bethesda, MD

Posted on Updated on

This is an opportunity to have enterprise-wide impact and see the world as part of the Office of the Medical Inspector General. A Captain is preferred, but a senior Commander will be considered. The desired report date is Fall of 2019. The position
description is here. The incumbent is CAPT Timothy Wilks (contact info in the global) if there are questions.

Applications are due (with Detailer/Specialty Leader concurrence) to the Corps Chief’s office NLT August 1, 2019. Please send to CDR Melissa Austin (contact info in the global).