Throwback Thursday Classic Post – The Book – Chapter 3 – Career Progression and Promotion Board Math
When you start your Naval career, the future is largely a mystery. As you progress in your career, things will crystalize, you’ll become wiser, and you’ll think, “It would have been nice to know all of this in the beginning.”
I’m going to try and tell you what you should have known about career progression and promotion board math from the beginning.
This diagram below demonstrates the typical career progression of a Medical Corps officer who has no prior service. Assuming you are not picked early for promotion, you typically promote every six years. You will become a Lieutenant Commander (LCDR) at approximately 6 years, a Commander (CDR) at 12 years, and a Captain (CAPT) at 18 years. I had no prior service, I have never been promoted early, and this is exactly the timing I experienced in my career.
Along the left are the ranges of promotion opportunity for each rank from fiscal year 2010-2021. In each year, the promotion opportunity for LCDR has been 100%. In theory, if all the Lieutenants are suitable for promotion they can all be promoted to LCDR. When it comes to the promotion opportunities for CDR or CAPT, interpreting them is a touch more difficult because we have to talk about promotion board math.
Promotion Board Math
In Fiscal Year 2019 (FY19), people were very excited about a 90% promotion opportunity for the FY19 Staff Corps O6 promotion board. But it was easy to misinterpret this opportunity. It did not mean that 90% of CDRs were selected for CAPT.
Where Does the Promotion Opportunity Come From?
The short answer is from manpower projections. How many physicians are getting out or retiring? What is the current Medical Corps manning level for that rank? What are future needs anticipated to be? What is the size of the promotion zone? The answers to all of these questions determines the promotion opportunity and guide Navy Personnel Command (NPC) and the Bureau of Medicine and Surgery (BUMED) when they are making their decision.
As you can see here, the promotion opportunity varies from year-to-year:
Historical promotion opportunities for FY10-21.
But as you can see here, the percentage who are promoted from the in zone group is substantially lower:
Historical percentage of in-zone candidates selected for promotion for FY10-21.
Promotion Board Zones
There are three “zones” for promotion – below zone, in zone, and above zone. Medical Corps officers are below zone for two years, in zone for one year, and above zone until they are either selected for promotion or get out of the Navy. A few people are usually picked early or below zone, but most people will not get picked until they are in or above zone.
FY19 O6 Promotion Board Math
In FY19, there were 74 CDRs in zone for promotion. To figure out how many officers can be selected for promotion, you have to multiple the zone size by the promotion opportunity. For example, if you take the 90% promotion opportunity everyone was excited about and multiply it by the zone size of 74, you’ll see that they could have promoted 67 CDRs to CAPT during the board:
90% opportunity X 74 people in zone = 66.6 (rounded up to 67) people they can pick for O6
These 67, though, were picked from CDRs who were below zone, in zone, or above zone. Usually, there is a small number picked from below zone, and a much larger number from the in zone and above zone categories. Here were the results:
As you can see, the 90% promotion opportunity only led to a 41% selection rate for those who were in zone. The remainder came from the below and above zone CDRs.
The Bottom Line on Career Progression
The typical career progression occurs with a promotion every six years, as detailed in the diagram below. The promotion opportunities listed, though, result in a much lower chance of getting picked when you are in zone because the selections come from those below, in, and above zone.
Navy Medicine has been undergoing a lot of change. We have a new Surgeon General, a new Corps Chief, and a renewed focus on readiness. With these changes come a new career progression and path for the Medical Corps (MC) Officer (PDF version, PPT version). Let’s take a look at the new model and discuss some of the ways it will impact you as your career progresses. We’ll start at the top of the slide and work our way down, translating it into action items for every MC Officer.
Intent and Expectations
What should a MC Officer note in this section? To be competitive for promotion, you need to have been operational AND clinical. The days of camping at Military Treatment Facilities (MTFs) are over. Everyone needs to be operationally relevant, and this is consistent with the most recent changes in the O6 promotion board convening order. It can be with the Surface Force, Fleet Marine Force (FMF), Undersea, Air, Special Operations, Joint environment, Expeditionary Combat Command, or any other operational setting you find yourself in. It doesn’t matter how or in what setting, but everyone needs to be operationally relevant.
Action #1 – Deliberately develop your operational relevance.
Recommended Medical and Professional Development Path
Very simply, this spells out your educational pathway. Completing residency and becoming board certified is not a new concept or path for the MC Officer. What is new, though, is the expectation that everyone will serve in an operational setting by the time they are up for promotion to O5 and in a more senior operational role before they are up for O6. The concept of everyone becoming an Operational Medical Officer (OMO) is explained in detail at the bottom of the slide.
In addition to serving as an OMO, the expectation is that those who want to serve in more senior roles will complete Joint Professional Military Education Levels I and II (JPME I/II) and obtain formal management or leadership training, such as a Master’s in Business Administration or similar degree.
Action #2 – Start JPME I now if you haven’t already, and develop a strategy and timeline with your mentors to obtain more senior education.
High Reliability Organization Training
The new SG is a huge proponent of high reliability, and Navy Medicine is constantly striving to adopt the principles of a High Reliability Organization (HRO). Many of the classes mentioned on the career path slide are undergoing modifications and updates to incorporate high reliability education.
Action #3 – Attend or complete the listed HRO courses.
The example assignments are divided into Fleet and Navy Medicine Readiness and Training Command/Unit (NMRTC/U) positions. They are also stratified according to the typical ranks at which they would occur. These are general guidelines and variability will certainly occur, so be flexible. For example, we know that it takes a minimum of seven years to become a Neurosurgeon, so their path will vary. Other specialties that require longer training are in a similar situation. As a result of this, we are going to ask each Specialty Leader to take this generic career path and modify it for their own specialty.
Another takeaway from this portion of the slide is to alternate between operational assignments and NMRTC/U assignments where you are serving primarily in a clinical role, likely at an MTF. Time at the MTF will allow you to solidify your individual clinical skills and contribute to our Graduate Medical Education mission. After that tour, return to the operational setting in a more senior role. Rinse and repeat this pattern as your career progresses.
Action #4 – Print the career path slide and get a red and black pen. In black circle the jobs, roles, and courses you’ve already done. In red circle ones you’d like to do. When it is time for your next set of orders, jump from realm where you currently are (Fleet or NMRTC/U) to the other and aim for one of the positions to the right that you circled in red.
An Example – My Career Path
Just to visualize the way we are encouraging you to use the career path slide, let’s take a look at My Career Path. I circled the things I’ve done in black, and the things I’d like to do in red.
As a 19 year O6, I have a lot of black ink, but there are some red circles to the right indicating the things I’d like to do. As the Deputy Corps Chief, I am currently in a senior headquarters role toward the right end of the Fleet portion. Most likely, my next career move will be to obtain JPME II or enter Executive Medicine as an Executive Officer (XO) because completing an XO and Commanding Officer (CO) tour is mandatory before I can compete for the more senior leadership roles. Use a similar analysis of where you’ve been (black ink) and where you want to go (red ink) to come up with options for your next career move.
The new MC career path should serve as the basic framework around which you structure your career. A quick summary of the actions you should take include:
- Deliberately develop your operational relevance.
- Start JPME I now if you haven’t already, and develop a strategy and timeline with your mentors to obtain more senior education.
- Attend or complete the listed HRO courses.
- Circle the jobs, roles, and courses you’ve already done in black. Circle ones you’d like to do in red. When it is time for your next set of orders, jump from the realm where you currently are (Fleet or NMRTC/U) to the other and aim for one of the positions to the right that you circled in red.
What better to do during a global pandemic than listen to a screencast about managing your career! Here are the PPT slides I used for it:
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 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
- Chief Medical Officer
- Major committee chair
- Medical Executive Committee President
- BUMED staff
- Specialty Leader
- Deployment requiring an O-5
- 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.
(Because the convening orders change very little from year to year, this post is still relevant today. Enjoy.)
The FY17 Staff Corps O6 Board Convening Order was released after conclusion of the board. The best news was that the promotion opportunity for Medical Corps was 70%, up from 50% last year, which was an all-time low. Aside from that, though, if you read through the convening order, it basically tells you how to get promoted to Captain. I’ve read through it and pulled out quotes that you can turn into actionable items. Enjoy:
“Their personal and professional attributes include…physical fitness…”
ACTION ITEM: Workout and never allow yourself to fail a PFA.
“…successful performance and leadership in combat conditions demonstrate exceptional promotion potential and should be given special consideration.”
“The board may give favorable consideration to those officers who have displayed superior performance while serving in IA (Individual Augmentee)/GSA (Global Support Agreement)/OCO (Overseas Contingency Operations)/APH (Afghanistan-Pakistan Hands) assignments that are extraordinarily arduous or which involve significantly heightened personal risk.”
“Success in these assignments [joint duty assignment billets] should be given special consideration…”
“Navy Medicine needs leaders with knowledge and experience in a variety of settings including operational medicine, joint medical operations, and current peacetime health care delivery initiatives.”
“Navy Medicine greatly values joint experience…”
“You must ensure that Navy Medicine’s future leaders possess the broad knowledge necessary to support the operating forces and are acknowledged leaders within their operational…specialties.”
“The officers selected must have demonstrated exceptional managerial skill and professional competence in executive and staff roles both in support of the fleet and Marine Corps and within the naval shore establishment.”
“…you should select those officers who have served in a broad spectrum of assignments requiring expertise in diverse functional areas.”
“…those you select will be placed almost assuredly in positions that require broad military and medical perspectives beyond the Department of the Navy.”
“Best and fully qualified officers for the rank of captain, will be those who have demonstrated experience and expertise across the spectrum of military treatment facilities, operational platforms in support of the fleet or the Marine Corps, and the intersection with the strategic and tactical issues in provision of military healthcare through experience in headquarters or other associated DoD agencies.”
ACTION ITEM: Deploy, preferably in a combat or joint environment, if available. PCS when you can, and take a variety of assignments, including senior operational positions and positions with other services.
“The board shall give favorable consideration to those officers with relevant graduate education…and Navy and Joint Professional Military Education (JPME).”
“The Navy values completion of graduate education and development of a subspecialty. Degrees from the Naval Postgraduate School, the Naval War College and equivalent Service institutions, and civilian education programs…are desirable.”
“Navy Medicine greatly values…formal education to include JPME I.”
“The Navy values completion of graduate education and development within and officer’s subspecialty.”
“The Navy values competitive scholarships and fellowships, examples of which include: Olmsted Scholar, Marshall Scholar, Rhodes Scholar, White House Fellowship, SECDEF Corporate Fellowship, and Federal Executive Fellowships (e.g., Politico-Military and Cyber).”
ACTION ITEM: Consider applying for one of these scholarships or fellowships.
“Duty or service in combined or other staff positions at the senior levels of government should also be considered favorably.”
ACTION ITEM: Don’t be afraid to take positions in senior levels of government organizations when they are available.
“You shall give consideration to an officer’s clinical and scientific proficiency as a health professional to at least as great an extent as you give to that officer’s administrative and management skills. Strong consideration should be given to board certification when a board certification exists for the specialty.”
ACTION ITEM: Get and stay board certified.
Throwback Thursday Classic Post – Normal Promotion Timeline and the Jobs/Achievements That Get You There
The typical career progression for a Medical Corps officer if promoted on time (the first time they are in-zone) is:
- 5 years – selected for promotion to LCDR
- 6 years – promoted to LCDR
- 11 years – selected for promotion to CDR
- 12 years – promoted to CDR
- 17 years – selected for promotion to CAPT
- 18 years – promoted to CAPT
For example, I’m a 15 year CDR, so I’ll be in-zone in 2 years at year 17. If I’m selected the first time I’m in-zone, I’ll be promoted to CAPT in year 18. (This just happened!)
There are 5 general career paths in the Navy that lead to promotion, and I firmly believe that all can lead to promotion to CAPT. They are:
One of my favorite things about the Navy is that you don’t have to stay within the same career path as you progress in your career. I have happily jumped around and managed to promote to LCDR and CDR on time. During my first tour at USNH Okinawa, I was largely clinical. After that I was academic but transitioned to more of an administrative role, culminating with my time as a Detailer at PERS. In my current role as Commander of a Joint Medical Group and Joint Task Force Surgeon, I’m both administrative and operational. My next tour will return me to an academic setting where I hope to score a major administrative role (I became the Director for Healthcare Business) at the command but once again “be academic.”
As you progress down your chosen career path, one of the major determinants of whether you will promote is whether you get the jobs that will allow you to progress to the next rank. The following lists include many, but certainly not all, of the collateral duties, positions, and achievements you should strive for once you reach each rank. If you can get some of these positions and do well in them, it should allow you to break out on your FITREPs and increase the chances you will promote. Of note, in each rank appropriate list there are positions from all 5 general career paths.
LTs or LCDRs looking to promote should focus on achieving these milestones or positions:
- Getting board certified, which is pretty much a requirement to promote
- Completing a fellowship, but trying to avoid being a fellow in the years right before they are in zone so that the non-observed FITREPs you often get don’t hurt your chances at promotion
- Completing a deployment, but again trying to avoid doing it right before you are in zone due to the small competitive groups you often get on your FITREPs
- Assistant/Associate Residency Director
- Department Head (DH) is a small/medium military treatment facility (MTF)
- Assistant Professor at USUHS, which is very easy to get if you just apply. See my promo prep document for the info on how to do this.
- Publishing professional publications
- Research, preferably defense-related
- Departmental collateral duties
- Hospital committee member or chair
- Executive Committee of the Medical Staff (ECOMS) member
- Civilian leadership positions, like in your specialty society’s state chapter, for example
- Senior Medical Officer (SMO) or Medical Director in your department at a large MTF
CDRs looking to promote should focus on:
- Residency Director
- DH of your department in a large MTF
- Associate Professor at USUHS
- Director position (Director of Medical Services, Director of Clinical Support Services, etc.)
- Officer-in-Charge of a clinic
- Chief Medical Officer
- Major committee chair
- ECOMS member, Vice-President/President-Elect, or President
- Senior operational leadership position
- Division Surgeon
- Group Surgeon
- Wing Surgeon
- Commander, Amphibious Task Force (CATF) Surgeon
- SMO on an amphibious platform
- Staff position at BUMED
- Specialty leader
- Deployment requiring an O-5 or higher
As a LT or LCDR, I was able to get board certified, complete a fellowship at the right time, deploy twice, become an Assistant Professor at USUHS, publish numerous publications, do some research, obtain numerous departmental collateral duties, chair a hospital committee and be an ECOMS member at USNH Okinawa, become a SMO in the Navy’s largest emergency department, be an Associate Director at a large MTF, and hold numerous civilian leadership positions.
As a CDR so far I have promoted to Associate Professor, been a major committee chair and member of ECOMS, and served a tour as a Detailer. Currently I’m a specialty leader and am deployed in a senior operational role that required a CDR or CAPT.
All of this took a lot of work, but made it easy for my leadership to fight for and justify early promote (EP) FITREPs that allowed me to promote to LCDR and CDR on time. Will it work for CAPT? We’ll have to wait on that (it worked), but the more of these things you can achieve, the easier it will be for your leadership to do the same thing for you. You need competitive EPs to promote, and doing these things, giving your leadership the ammunition to justify EP FITREPs, is the path to getting them.
Many Medical Corps officers don’t understand the difference between their Specialty Leader and their Detailer. After you read this post, this won’t be a problem.
DIFFERENCE #1 – WHO THEY WORK FOR
A Specialty Leader works for Navy Medicine (BUMED), the Surgeon General, and the Medical Corps Chief while a Detailer works for Navy Personnel Command (NPC or PERS). NPC/PERS is a line command, while BUMED is obviously medical. This difference is probably not of significance to the average Naval physician, but it can make a difference at times because these two commands (and people) will look at things from a different perspective.
For example, let’s say you are one of two subspecialists at NMC Camp Lejeune and you have a fairly light clinical load. You decide you want to leave early to get to your next command, Naval Medical Center Portsmouth (NMCP), because they are actually down one provider in your specialty due to the illness of another member of your community. Your Specialty Leader will probably endorse this early move because it makes sense. You are underemployed at Lejeune and there is a need at NMCP.
Your Detailer, however, will look at it differently. First, you haven’t served your full tour, so moving you early will require a waiver that may be denied by PERS. This largely has to do with money and PCS rules and has nothing to do with your specialty or the needs of the Navy. I’m not saying that Detailers don’t care about the needs of the Navy because they do, but they are constrained by the rules of PERS while a Specialty Leader is not.
DIFFERENCE #2 – WHAT THEY DO
A Specialty Leader serves as a liaison between you, BUMED, and your specialty as a whole. He or she also coordinates deployments, although the control they have over this was lessened by the return to platform-based deployments (deployments determined by what billet you are in or what unit/platform you are assigned to rather than whose turn it is to deploy). They also serve as a consultant both to you and your Detailer when it comes to career management and PCS moves.
A Detailer is your advocate to help you advance in your career, prepare for promotion boards by improving your officer service record, and negotiate orders for your next PCS. They will often speak with both you and your Specialty Leader while trying to balance your needs with the needs of the Navy. They also are the final approval authority for extension requests and actually write your PCS orders.
DIFFERENCE #3 – WHAT THEY DON’T DO
Specialty Leaders do not write orders. Many physicians think that the Specialty Leader is the one who decides what orders they get and where they PCS, but the reality is that Specialty Leaders can’t write orders. Only Detailers can, therefore it is the Detailer who makes the final decision in nearly all cases. If there is a good Specialty Leader-Detailer relationship, most of the time both are in agreement and there is no controversy, but about 5% of the time there is at least some level of disagreement that has to be worked out.
Detailers can write your orders to a command, but they do not influence who gets command-level leadership positions. For example, you may want to go to Jacksonville to be the Department Head of your specialty’s department. A Detailer can write you orders to Jacksonville, but which physician the command picks to be Department Head is up to them, not the Detailer (or the Specialty Leader).
Specialty Leaders will often talk to commands, but Detailers usually do not. The Detailer is SUPPOSED to talk to three people – you, the Specialty Leaders, and the Placement Officers. The Placement Officers are officers at PERS who represent the commands. You can think of them as the detailers for commands. They make sure that commands aren’t taking gapped billets, that the providers sent to the command meet the requirements of the billet they are entering, and weigh in on other issues like extension requests.
I say that a Detailer is SUPPOSED to talk to three people and USUALLY does not talk to commands, but the reality is that commands frequently call the Detailer instead of talking to their Placement Officers. This often happens because the Director at a command knows the Detailer but doesn’t know the Placement Officer. In addition, the Detailer is usually a physician (3 of 4 Medical Corps Detailers are physicians, the 4th is a MSC officer) and the Placement Officer is always a MSC officer. Physicians like talking to other physicians.
Finally, Specialty Leaders do not alter your officer service record. In fact, unless you send it to them, they can’t even see it or your FITREPs. Detailers, on the other hand, can see just about everything and can update/change some things, mostly additional qualification designators or AQDs.
WHY SHOULD I CARE ABOUT ANY OF THIS?
Because you must actively manage your career to get what you want. This means you should talk with both your Specialty Leader and Detailer 9-18 months ahead of your projected rotation date (PRD). You should discuss your short and long-term goals, whether you want to PCS or extend, whether you are planning a Naval career or want to resign or retire, your family situation, and your medical situation if applicable.
Most importantly, though, is to be honest with both your Detailer and Specialty Leader. Most Specialty Leaders get along well with the Detailer, so if there is any disagreement between the three of you make sure that you keep things professional and respectful at all times. It’s a small Navy and, to be honest, it will be readily apparent if you are playing one off against the other.
By Joel Schofer, MD, MBA, CPE
(Note: The views expressed in this chapter are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.)
There are many career paths available to Medical Corps officers. The five primary career paths include:
All of them can lead to promotion to O6. Here is a slide summarizing the Medical Corps career paths:
When comparing a Naval career to a civilian one, it is often easier to jump from one career path to another in the Navy than it would be in the civilian job market. All it takes is for you to take a new set of orders and you have switched career paths without having to start over. Let’s discuss the five career paths.
Academic Career Path
The academic career path involves much of the same activities as in the civilian world. You will largely be stationed at military treatment facilities (MTFs) with graduate medical education (GME) programs. In the Navy, these will include Family Medicine teaching hospitals/medical centers (Camp Lejeune, Camp Pendleton, Fort Belvoir, Jacksonville), Japanese MTFs with Japanese internships (Okinawa, Yokosuka), and medical centers with multiple residency programs and internships (Bethesda-Walter Reed, Portsmouth, San Diego). In addition, you could be stationed at the Uniformed Services University of the Health Sciences (USUHS) or in an educational support role at the Bureau of Medicine and Surgery (BUMED).
Aside from your clinical activity, you’ll be focusing on teaching and academic production. If you’re smart, you’ll work toward academic promotion in your department at USUHS by obtaining a faculty appointment (this newsletter tells you how to get one) and progressing toward academic promotion. Once you graduate from residency, you will likely be appointed an Assistant Professor, which means you are considered a local or regional expert. The next step would be to promote to Associate Professor, where you are a regional/national expert. Finally, you would strive for Professor, which usually indicates you are a national/international expert in your field.
If you receive a USUHS faculty appointment and, with the guidance of your USUHS department, actively work toward academic promotion, your academic career will be forced to progress. In my experience, most people obtain their initial appointment as an Assistant Professor but never progress from there. If you want to progress, you will need not only a curriculum vitae (CV) and biography, but also an educator’s portfolio. This portfolio can be a lot of work to create and maintain, and it is infinitely easier if you start early in your career.
The other relatively recent development in the academic career path is that there are many more options that are considered acceptable academic productivity. Traditionally, you had peer-reviewed publications and book chapters but little else. With the rise of the internet and social media, smartphone applications, blogs, podcasts, and other on-line options exist for you to produce academically and build your expertise and influence.
Research Career Path
The research career path is much like the academic one just discussed, but with a research focus. You would likely spend most of your career in MTFs with GME programs, but you can really do research anywhere in the Navy. Of particular interest, the Navy has commands whose primary missions are research, like Naval Health Research Center, Naval Medical Research Unit Dayton, and others.
Anyone planning a research career, you should strongly consider obtaining advance training. This could involve a fellowship, an advanced degree or certificate program, or additional continuing medical education. USUHS offers training in research.
Administrative Career Path
The administrative career path usually starts when you assume a leadership role appropriate for a junior to mid-grade officer. This would include Assistant Department Head, Department Head at a small/medium Military Treatment Facility (MTF), Medical Director, Senior Medical Officer, a leadership role on the Medical Executive Committee (MEC), or any other position where you assume administrative responsibility.
After the initial role, you gradually assume more responsibility, potentially at larger and at different types of commands. Although it is possible to obtain some of these roles as an O4, once you are selected to O5 a new world of positions is open to you that is easier to obtain as a CDR or CAPT. These would include Chair of a MEC committee, Department Head at a large MTF, Associate Director, Director, MEC Vice-President or President, Chief Medical Officer, Officer-in-Charge, or other positions with significant leadership roles. Once you are selected for O6, you can transition into Executive Medicine and can screen for Executive Officer and later Commanding Officer positions. If you are successful in your senior O6 leadership positions, you may be considered for promotion to the flag ranks as a Senior Healthcare Executive.
Many physicians who hope to rise to high levels of administration will try to increase their knowledge base by obtaining additional training. This can include military course like MedXellence or the Senior Officer Course in Military Justice and Civil Law. It can also include formal education in management and administration, such as a Master’s in Business Administration, Medical Management, or Healthcare Administration. There are many ways to obtain these degrees both inside and outside the service.
Clinical Career Path
The clinical career path is probably the purest and most natural career path. Why did you go to medical school? Usually, it is because you wanted to be a doctor, and the Navy needs people who want to be a doctor.
The first step in pursuing a career path is to complete a residency or fellowship in your desired field(s) of choice. After completing this graduate medical education, although not required by the Navy, you should strive to achieve board certification in these specialties, if available. First, it allows you to receive board certification pay. Second, it allows you to get a 5 in the professional expertise trait on your fitness report. Third, it is generally required to promote. Finally, when you moonlight or get out of the Navy, you will earn more than someone who is not board certified. And we all eventually get out of the Navy!
After achieving board certification, it is assumed that you will maintain it. In fact, it is required to continue receiving board certification pay. If you ever let your certification lapse, you must notify your special pays coordinator so they can terminate the board certification pay.
The downside of a purely clinical career path is that it can make it harder to promote to O6 if all you do is see patients and you are not willing to take on at least one significant collateral duty. I’m not saying it is impossible to promote as a pure clinician, but it can make it harder. On the positive side, a board certified clinician should be able to promote to O5, and some of the Commanders I know who are purely clinicians are some of the happiest physicians I know. You want me to join that committee? No thanks. I’m happy just being a doctor!
Operational Career Path
Many physicians pursue an operational career path because it is why they joined the military. You can be a doctor anywhere, but in the Navy you can be in submarines, dive, parachute, and all sorts of other fun and unique things.
An operational career path most commonly begins with a tour as a General Medical Officer (GMO) with the Marines or on a ship, a Flight Surgeon (FS), or Undersea Medical Officer (UMO). For those that go straight through in residency training, it may be that their first set of orders after residency takes them to an operational billet. In either case, physicians with an operational unit will probably find that they have a lot of responsibility for people with a work hard, play hard mentality. The 72 and 96 hour periods of leave that are common around holidays (play hard) are balanced by the requirement to deploy or train in the field (work hard).
As a physician promotes and becomes more senior, there are often opportunities to assume more senior roles specific to the operational community of choice. Along the way, it will be assumed that you are maintaining your clinical skills. Because it is often difficulty to maintain a full scope of practice in an operational setting, this may require extra effort to practice in a Military Treatment Facility or moonlight in your free time.
In summary, there are five primary career paths in the Navy. They include academic, administrative, clinical, operational, and research. In the Navy, it is usually fairly easy to transition from one career path to another without losing a step. Finally, pursuing all of them can lead to a fulfilling career and promotion to O6.