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.
(It is funny to read this 3 years later, as much of it is true to this day, as you’ll read in my 2019 notes in italics below.)
In my opinion, every Naval physician needs to have a list of people. On this list are the people who you absolutely, positively will not mess with. When you talk to them, you show them the utmost respect. When they ask you for something, you give it to them better and faster than you ever give anyone anything. These are the people who have determined your career path to this point and are likely to continue to steer if for the near future.
Who’s on your list? If you don’t know, you should think about this as soon as you can. You might think it is silly, but I’d actually make a list. Just to show you I’m serious, I’ll share my list (as it was when originally posted on the blog):
- Current Emergency Medicine (EM) Specialty Leader
- Prior Deputy Commander of NMC Portsmouth
- Prior EM Specialty Leader
- Current Director of Medical Services at NMC San Diego
- Prior EM Specialty Leader and Deputy Medical Corps Chief
Why are they on my list? They are Emergency Physicians like me, and they are the most senior and potentially influential people in my career. They are the people who are senior to me, well thought of in my specialty, and get phone calls or in person inquiries when I apply for a leadership position. For example, one of the people on this list thought of me when the Detailer job became available and endorsed me for it. (That same person just made me the incoming Deputy Medical Corps Chief. I show up at BUMED on September 3rd.)
Who’s not on my list? There are no admirals on my list (at least there weren’t at the time – there certainly are now). As a CDR, it is rare that I’m on the radar of an admiral. Some of them know who I am, and some of them could have a major impact on my career path, but it is unlikely that they’ll take a huge interest in my career until I’m a CAPT and qualify for major leadership positions working directly for them (somewhat of a prescient post, I guess). If an admiral wants to know about Joel Schofer, they’ll probably call one of the CAPTs on my list and ask them about me.
Who should be on your list? The people you should consider putting on your list include:
- Your Specialty Leader and prior Specialty Leader
- Your Detailer
- Influential people in your specialty who are 1-2 ranks senior to you
- Whoever is currently in the job(s) you want
Undoubtedly there are other people you should consider, but this list is a good start.
Once you create the list, here are the things you need to keep in mind. Always treat these people with the utmost of respect. You should always treat everyone with respect, but these people get special attention. Never get into an argument with them. I’m not saying you have be a “yes man” (or woman) and agree with everything that they say, but any disagreement needs to be collegial and respectful. You want to prevent them from getting mad at you, if at all possible. When they ask you for something or they give you a task, it immediately rises to the top of your to-do list. In addition, you never give them anything but your best, maximal effort.
The Navy is a large organization that can appear impersonal, but people run it. The people on your list are the ones who are going to determine your future and whether you get want you want or not. If I were you, this is one list I’d put some thought into and actually make.
There are many important dates in your Navy career. One of the most important and neglected dates, though, is your projected rotation date or PRD. Your PRD is the month and year that your current orders will expire and you are scheduled to rotate to a new command. If you don’t manage your PRD and pay close attention to it, you can find yourself with few career options and in a situation you never thought you’d be in. With that in mind, here are my tips for managing your PRD.
First, know when it is because many physicians don’t know their PRD. If you are in this crowd, the easiest way to find your PRD is to login to BUPERS On-Line and look at block 14 of your Officer Data Card:
The other way to find your PRD is to contact your detailer because they can look it up in the detailing system. Many physicians don’t know their detailer, so here is a link to a page with “Contact Us” in the middle. That link will take you to your detailer’s contact info, but note that it is CAC protected:
Once you know your PRD, the easiest way to manage it is with whatever calendar you use (an app, web calendar like Google Calendar, Outlook, a date book, etc.). Place reminders in your calendar to correspond with these time frames:
13-18 MONTHS BEFORE YOUR PRD – This is when you should start thinking about your next career move. Although the normal time period to request an extension (find a template here) at your current command is 9-12 months before your PRD, many physicians request an extension during this time period if they are sure they want to extend. This is also a great time to talk to the operational detailer about operational billets you might have interest in or the senior detailer about what I’ll call “alternative billets” like those at DHA/BUMED, BUPERS, global health engagement billets, NAVMEDWEST, NAVMEDEAST, etc. If you act on your PRD in this timeframe, you’ll be well ahead of the game.
9-12 MONTHS BEFORE YOUR PRD – This is the traditional detailing window where you contact your detailer and specialty leader to negotiate your next career move. This is when physicians normally submit an extension request as well as explore potential billets for their next set of orders. The one caveat is that the availability of billets is often contingent on the results of the Graduate Medical Education Selection Board or GMESB. Since these results are not finalized until January, people with summer PRDs will find that they may have to wait beyond this time period to find out what billets are available and get orders.
6-8 MONTHS BEFORE YOUR PRD – This is when the list of billets that are actually available will solidify and most physicians will get orders. If you want to extend at your current command and you haven’t submitted an extension request yet, you should do that ASAP.
1-5 MONTHS BEFORE YOUR PRD – Many physicians will get into this period without orders. If it is because you were waiting on the results of the GMESB, you are probably fine. If you are in this period for another reason, you should get nervous. The truth is that unanticipated things always happen. Commanding Officers don’t endorse extension requests. Unanticipated openings cause a detailer and specialty leader to have a “hotfill” billet. When things like this happen, a detailer goes looking for officers close to their PRD to fill the need. If you are in this window without orders, you are low lying fruit for filling these needs. And just so you know, most of these “hotfills” are not in Rota or San Diego.
AT YOUR PRD OR BEYOND – Physicians let their PRDs pass all the time. Sometimes it is because they submit an extension request that never gets approved because it gets lost somewhere in the process. Other times they don’t know when their PRD is. Realistically, there is often no consequence if your PRD “expires,” although some commands will pick up on this fact and get your attention by threatening to take away your computer access. The biggest threat, though, is the aforementioned “hotfills” that inevitably show up. If your PRD is expired, you are going to rise to the top of the list when the detailer goes looking for people to fill that need. Have fun wherever that “hotfill” is.
THE BOTTOM LINE – Know when your PRD is and manage it according to the above timeline. This will give you the maximum chance of getting what you want and reduce the chance that you are selected for a “hotfill” you don’t want.
(You can find all of my FITREP education here, including the FITREP Prep document.)
When I was a Detailer, I would review a lot of records for people who failed to promote. Over and over again I would see FITREPs that reflected poorly on the officer. A lot of the time they didn’t realize it was even an issue, and sometimes they did it to themselves. Here are the top 5 FITREP mistakes you want to make sure you don’t make:
- Getting anything other than an early promote (EP) when you are getting a 1/1 FITREP, also known as an “air bubble.”
If you are the only officer in your competitive category (meaning that you aren’t competing against anyone on that FITREP), make sure you get an EP. Just like a single air bubble, you should “rise to the top” and get an EP. If you don’t get the air bubble and get a promotable (P) or must promote (MP), it reflects poorly on you unless it is CLEARLY EXPLAINED in the narrative why you are getting a P or MP. Here you can see an officer who got a 1/1 MP in his/her last FITREP and how it would be noted at a promotion board:
For example, if your reporting senior doesn’t give newly promoted officers an EP, your narrative should say something like, “Newly promoted officers do not receive EP rankings.” Sometimes this happens because your reporting senior is an officer from another service and he/she doesn’t understand the “Navy rules” for FITREPs. Sometimes it happens because either you or your reporting senior wants to give you a P or MP so you can “show progression” and get an EP. If you want to show progression, do it on the overall marks, not the final promotion recommendation. For example, give yourself a 4.0 EP, then a 4.17 EP, and finally a 4.33 EP. DO NOT give yourself a P or MP if you are getting a 1/1 FITREP.
- Both officers in a competitive group of 2 getting a MP FITREP.
If you are in a competitive group of 2, your reporting senior should give 1 of you an EP and the other a MP. If he/she gives you both a MP, it reflects poorly on both of you. Most often this will happen at an operational command and/or when there are 2 officers who are competing but are in the same promotion year group. Make sure your reporting senior doesn’t take the easy road and give you both a MP. One of you should get the EP, and the other can get a MP with a strong narrative explaining why.
- Declining from an EP to an MP without changing competitive groups (or “moving to the left”).
Most often I would see this when a resident who was in a large competitive group was given an EP FITREP. Then when they graduate from residency, their competitive group shrinks and they don’t get an EP but are left with an MP. Here’s what it looks like on when projected at the promotion board:
If I was you, I’d fight this like a dog. If they can’t keep you at an EP and you didn’t do anything wrong to deserve this, make sure the reason for your drop from an EP to a MP is clearly explained in the FITREP narrative.
If this happens to you because you are changing competitive groups, like when you get promoted or move from residency/fellowship to a staff physician at the same institution, it is not a black mark in any way and is expected.
- Not getting a 5.0 in Leadership.
If you are writing your own FITREP, you can’t give yourself a 5.0 in every category, but of all the categories Leadership is probably the most important one. Make sure you give yourself a 5.0 in Leadership because that is what the promotion board is looking to promote, future leaders. Having less than a 5.0 can send a bad message to the board.
Sometimes you have no control over this, and sometimes you may deserve less than a 5.0 in Leadership, but do your best to get a 5.0 there if at all possible.
- Giving yourself an overall trait average less than your reporting senior’s average.
Every reporting senior has an overall trait average for each rank that includes all of the FITREPs that they’ve done for that rank. You want to try and find out what it is.
While a reporting senior can look up their average on BOL, you can’t. You can, though, see it on your Performance Summary Record if you’ve received a FITREP from them at your current rank. Although it changes every time they do more FITREPs, their average the last time they did a round of FITREPs can be found on your PSR and is highlighted below by the red arrow with blue text (this reporting senior had ranked 6 LCDRs and had an average of 3.50 at that time) on one of the slides from my FITREP video podcast:
If you have never received a FITREP from your reporting senior at your current rank, maybe your one of your friends has. The other way to find out their average is to ask your chain-of-command. Someone, usually the command’s FITREP coordinator, will know their average for your rank.
It is probably obvious that once you find out their average, you’d like to make sure you are above it. Sometimes there is nothing you can do to be above it because you are getting a P and/or you deserve to be below it, but make sure you don’t rank yourself below it if given the chance to write your own FITREP.
In summary, those are the top 5 FITREP mistakes I often see. If you are interested in learning more, grab a copy of your FITREP and watch this video podcast. In 45 minutes you’ll know everything you need to know to write effective FITREPs.
It’s August and a whole new crop of recent residency graduates can now moonlight for the first time in their Naval careers, so here is a video and blog post that discusses some of the basics of moonlighting.
Should You Moonlight?
I think the answer to this question depends on a lot of things. First, do you envision yourself working clinically when you leave the Navy? For most physicians, the answer to this question is yes, and depending on your specialty you may need to moonlight to maintain your clinical skills. We don’t always get exposed to the full scope of our specialty in the Navy. My wife is a pediatrician, and when she was on active duty I thought she had a full scope pediatric practice and did not need to moonlight to maintain her skills. As an emergency physician, though, it is rare to get exposed to the full breadth of emergency medicine in a Navy emergency department. You have to make an honest assessment of your specialty, the breadth of your Naval practice, and whether you need to moonlight to maintain your skills.
In addition, you need to figure out your motivation for moonlighting. A common motivation is to earn extra money, and that is a fine motivation, but you never want to make decisions that make you dependent on the money. You may deploy, your CO could take away your moonlighting privileges, or you could PCS somewhere where you can’t moonlight. You don’t want to be the bankrupt doctor because you bought a house you can’t afford without moonlighting.
The Navy’s Moonlighting Rules
In order to moonlight you have to get permission from your command. It is a privilege, not a right, and you can lose this privilege if you fail a PFA, don’t stay up-to-date on your training/readiness requirements, or don’t produce academically when required.
If you are going to moonlight somewhere outside of a 2 hour drive, you need to take leave. If you are flying anywhere, no matter the distance, you need to take leave. You can’t moonlight more than 16 hours/week and you need to have 6 hours of time off between clinical periods for your moonlighting job and your Naval duties. You’ll need to complete an annual attestation that says you are aware of these policies and compliant with them. If your specialty makes complying with these guidelines hard, you can ask for a waiver from your command.
Where Should You Moonlight?
If you moonlight locally you don’t need to take leave. If you can find a clinical setting you think you’d like after your time in the Navy is complete, you can even start working toward partnership.
If you work locum tenens, you can travel and sometimes chase “the big money.” If you work enough, the locum companies will cover all of your expenses, DEA, state licenses, travel, hotel, expenses, and malpractice insurance. Because you are likely traveling to a location more than a 2 hour drive away, you’ll need to take leave.
Basic Financial Planning for Moonlighters
Moonlighting allows you to put more money in tax advantaged retirement accounts. If you’re a non-moonlighter, you’d be limited to putting $19,000/year in the TSP and $6,000/year in your IRA (based on 2019 limits). If you moonlight and get paid on a 1099 as an independent contractor, you can fund a SEP IRA or solo 401k up to $56,000/year. It is rare that you’ll hit this maximum because you can’t moonlight enough to earn the amount required to do it, but you will be able to put more away than a non-moonlighter. A SEP IRA is easier to set up than a solo 401k, but a Solo 401k allows more money to be contributed at an equivalent salary. Plus, a SEP IRA messes up your backdoor Roth IRA contribution. For a great discussion on these two options, go to this article, but the bottom line is you’ll likely want to set up a Solo 401k and not use a SEP IRA:
Finally, moonlighters often want to incorporate because they think it provides malpractice protection, but that is a myth. Although there may be some tax advantages to incorporating, it doesn’t protect you from professional liability or malpractice.
If you are going to sign a contract, you are going to need to get some professional help. You should hire a healthcare or contract attorney to review any contract you are considering. You could also consider using a company that specializes in reviewing physician contracts like Contract Diagnostics. There are many issues you need to understand, including:
- Due process or termination clauses – For what reasons can they terminate you? Are you entitled to a hearing with the medical staff before your privileges are removed or restricted?
- Tail coverage – Does your malpractice insurance require tail coverage? If so, who is paying for it? Tail coverage is malpractice insurance that covers you after you stop working for that employer, and it can be VERY EXPENSIVE so you will want to know who is paying for it.
- TRICARE or VA eligible patients – You can’t bill these patients as they are already entitled to your services. This is spelled out very well in the moonlighting paperwork you will file with your command, but make sure your employer understands this.
Here are the Powerpoint slides for the video podcast below:
There is a HUGE knowledge deficit in the Medical Corps about FITREPs, which is sad when you consider that they are probably the most important document in our Naval careers. To address this deficit I created this video podcast. In 43 minutes you’ll know just about everything that you need to know about FITREPs. This material is based on about 10 lectures I collected over the years and is consistent with the 2015 update of the FITREP instruction.
Grab a FITREP to look at or start up NAVFIT98a and write your FITREP as you watch the video because it will be much easier to follow along this way. In addition, here are the slides to download and view and the page with all my FITREP resources:
When discussing why they failed to promote, one of the more common reasons that officers give is that they were unable to get a leadership position. When I ask them how they prepared themselves for these positions and what they did to improve their chances of getting one, they often don’t have much to say. Frankly, they didn’t do anything “extra” or above and beyond their normal duties to prepare for and get a leadership position.
Don’t be one of those officers.
The recipe for promotion is fairly simple. Superior performance in leadership positions leads to early promote (EP) fitreps, which leads to promotion. As promotion gets more difficult, the competition for leadership positions is likely to increase, and officers need to find a way to differentiate themselves from the crowd, increasing the chance they’ll get leadership positions. Obtaining a master’s degree can be one of the things that will distinguish you from other physicians and can dramatically increase the chances that you are competitive for career advancing positions.
What Kind of Degree Should You Consider Getting?
This depends on your career goals. If you want to become a leader in research or global health engagement, an area of increased focus in the Navy, you probably want to get a Master in Public Health (MPH) or similar degree. If you want to become a residency or fellowship director, a master’s degree in adult or medical education would fit the bill. If you want to become an operational leader, attending a war college would make sense. And if you want to become a clinical administrator or pursue executive medicine, obtaining a management degree, such as a Master in Business Administration (MBA), Master in Medical Management (MMM), or Master in Healthcare Administration (MHA), would make sense to me.
How Can You Get a Master’s Degree While on Active Duty?
There are many ways you can do this, but the most common include:
- Complete a fellowship that includes a master’s degree. Some fellowships either include or have the option of obtaining a MPH, such as the Global Emergency Preparedness and Disaster Response Fellowship. I also know of multiple officers who asked the Graduate Medical Education Selection Board for an additional year of fellowship to obtain a degree or simply for permission to obtain a degree alone. What are the chances this will be granted? Well I’m sure the chances change from year to year, but they are zero if you don’t ask.
- Complete the distance learning Executive MBA from the Naval Postgraduate School. This is how I got my MBA for the cost of books alone, and I think the program is excellent. You have to go to Monterey for 1 week at the beginning of the 2-year program, but after that all classes are held on-line.
- Apply for the Navy Career Intermission Program and take time off to get a degree.
- Attend a war college. Intermediate colleges are for officers who are O4 or below, while senior college is for O5 and above. If you’re interested, contact your Detailer.
- USUHS offers a Master in Health Professions Education.
- Pay for it yourself and do it in your free time on-line or in person. One program to look into is offered by the American Association for Physician Leadership (https://www.physicianleaders.org/education/physicians/masters). By taking some CME you can then enroll in various patient safety and management degrees that are all physician focused. The on-line University of Massachusetts healthcare focused MBA that they offer is the most reasonably priced MBA that I could find that is accredited by the top business school accreditation body. If you want a fast MBA (but pricey), look into the University of Tennessee Physician Executive MBA program (http://pemba.utk.edu).
While committing to a master’s degree program will take major time and effort, that is the point. It is a well-recognized way to demonstrate to the Navy that you’ve made a serious commitment to your professional development and could go a long way toward giving your next interview for a leadership position.