Last week was the Specialty Leader Business Meeting, which is always held in conjunction with the GME Selection Board. If you want to see the following Powerpoint decks, they are available on the Medical Corps Sharepoint Site (pick your e-mail CAC certificate or it won’t open for you):
- DHA Organizational Update
- Finding Joy in Work
- GME Interdependency Brief
- GME Overview
- Military Unique Curriculum
- PERS Pearls
I would post them, but the one about DHA is labelled “for internal use only” and there are too many authors of the other ones to get permission to post them on the blog. Because of all the change going on, I wanted to call attention to their availability.
Here is the latest update we were sent on extension requests:
As always, the MILPERSMAN is our guidance for billet assignments. Here is our current interpretation of the MILPERSMAN regarding extensions:
Extensions will be considered on a case-by-case basis when the following conditions have been met in the specialty:
- Operational billets are all filled
- OCONUS/remote duty stations are filled with appropriate medical officers (can’t all be new-residency graduates)
- All CONUS billets are filled (no gaps)
- Desirable billets have been considered for members coming from undesirable commands
- Egregious Time On Stations will be viewed critically
Multiyear extensions will be considered in the minority of cases. Scenarios where they may be considered include:
- Two-year extensions for newly named directors or department heads for large departments
- Program directors per ACGME requirements
- Co-locations for the above two
- Small communities where no one wants to move
- Statutory retirement in 2 years
If you have any questions, contact your Detailer.
Please see this note from the GME Detailer. Of note, I don’t have the list of available billets (but probably wouldn’t post it for OPSEC reasons even if I had it). I’d contact her if you need it (her contact info can be found here):
1. This notice is for ALL PGY1’s who intend to request GMO tours (do not have active applications submitted for GMESB consideration). If you have an active application in MODS, there is no need for you to take any action; merely wait for the GMESB to publish selection results in December…best of luck to each of you!
If you DID NOT apply, please pay attention to the steps below:
2. In order to secure PCS funding/estimate PCS budget, I am going to enter negotiations with PGY1’s (desiring GMO tours) earlier than normal.
- Monday, 11 SEP 2017 starting at 0700 CDT you may call in to discuss available GMO billets ***again, this call-in time is ONLY for those people who DO NOT have a MODS application/are not requesting consideration for GME ***
3. Please review the attached list of downstream billets. Have at least 3 choices selected from this list prior to calling/contacting me (preferably not all in the same area/type billet). Do not request a billet you are not eligible for (for example, do not select a billet marked “2nd tour GMO”), it creates frustration for both of us!
4. If you have co-location or EFM concerns, please ensure your status is current/updated prior to negotiating orders; otherwise I will be unable to complete the detailing process with you. If you are unsure of your status, feel free to contact me.
*** This slight departure from previous PGY1 detailing will hopefully provide official orders in a more timely manner and also load balance the detailing phone calls. There will always be billets for people, so no one should be stressed about having a “home”. It is not mandatory to call on the 11th of September to request orders, but that will be the first available opportunity for PGY1’s to select follow-on GMO duty station assignments.***
Kayreen K. Gucciardo
LCDR, MSC, USN
Medical Corps Assignments (PERS-4415R)
GME Placement / GMO Detailer
by Richard Childers, MD, Will Beasley PhD, and Joel Schofer, MD, MBA, CPE
The Navy recognizes the need to improve the detailing process and has explored a number of efforts to modernize assignment practices. An example is the Detailing Marketplace (DM) Pilot Project that was used to assign the 2017 Emergency Medicine billets. The DM optimized billet assignments by leveraging the best practices of market design economics.
In a traditional marketplace, money is a tool that facilitates transactions. Buyers can review products, consider their cost, and then purchase a desired product. Once the buyer chooses an item, a transaction can proceed.
In contrast, a Matching Marketplace (MM) requires two sides to select each other. Examples include medical students matching to residencies, law students matching to judicial clerkships, and high school graduates matching to colleges. For officer assignments, the Navy has a potential MM in which commands and officers select each other. We say “potential” because some commands may have input into assignments, but many do not.
Market Design is the field of economics that focuses on optimizing these markets. One prominent economist, Al Roth—Professor of Economics at Stanford—won the 2012 Nobel Prize in Economics for his work in this field. One of his most notable achievements was designing the National Residency Match Program that matches civilian physicians to their residency training positions. In his book, Who Gets What and Why, he describes the three components to an ideal MM: they should be (a) thick, (b) safe, and (c) uncongested.
A thick market has lots of buyers and sellers; the more options a buyer has to choose from, the more likely they will find something suitable to their unique taste. This principle is easy to understand; would you rather see all the billets available to Medical Corps officers or just the top three the detailer thinks are appropriate for you?
One reason the Navy is structured towards a thin market is our general tendency for rolling admissions to the marketplace. As individuals approach their Projected Rotation Date (PRD), negotiations commence. Individuals tend not to see the range of billets available, just the ones near their PRD.
A second important reason why officers are not presented an abundance of billet options is due to the cumbersome nature of the mechanics of detailing. The process of advertising billets involves pulling data from our detailing software, translating that data to an Excel file, and then emailing that to members or Specialty Leaders. Each one of these steps is cumbersome and provides an opportunity for error. It is also time-intensive, which makes it less likely the detailer will maintain an accurate product.
To create a thick market in our pilot project, we forced every possible officer with a PRD in FY17 who wanted an Emergency Medicine billet into the match. From the 58 Emergency Physicians who were eligible for orders in 2017, 12 were issued orders outside the match, resulting in a 79% participation rate. Reasons for exclusion included: sub-specialty training and assignment, co-location, non-Emergency Medicine operational billets, promotion, extensions for retirement, and pending administrative issues.
In July 2016, 46 billets (35% operational and 20% OCONUS) were posted for the 46 participating officers to consider. Commands were provided contact information for all 46 officers so they could initiate recruitment efforts if they desired. Parties were given several months to interact in whatever manner they determined appropriate; typically this involved officers sending their CV and arranging an interview with the command’s Department Head. In January 2017, commands and members independently submitted rank lists that were entered into the matching algorithm.
The best MMs are safe. A safe marketplace is one in which the buyers and sellers can act in their own self-interest without negative consequences; where desires can be freely expressed without a need to strategize the system. Unsafe MMs come up frequently in systems that emphasize the importance of giving buyers their “first pick” which might, at first glance, be a reasonable metric to measure the success of a marketplace.
The problem with this metric is that it forces participants to approach the system differently because officers who do not get their first pick have a decreased probability of getting their second pick. Consider an officer who really wants Naval Medical Center San Diego (NMCSD), a highly sought after location, but would be happy at Naval Hospital Camp Pendleton (NHCP) which is less competitive. Now imagine the detailer wants to give the officer their first choice. In this scenario, the officer has an incentive to tell the detailer that NHCP is their first choice to ensure she at least gets her second pick, even though she would have preferred a tour at NMCSD. This is because in a system that prioritizes giving people their first choice, the detailer is more likely to provide a less competitive officer NHCP if it is listed as their first choice. An ideal system would allow the officer to list her true preferences without diminishing her chances at other commands. In the example above, our officer should be able to list NMCSD first, without diminishing her chances of matching at NHCP if listed second.
A key to a safe matching marketplace is the use of the deferred acceptance algorithm (DAA). This is the algorithm economists have used to maximize outcomes in various matching marketplaces, including the National Residency Match Program. (For a brief demonstration, we recommend watching this video.) Put simply, this algorithm allows participants to rank their true desires and not have the order in which those desires are placed affect the final outcome. In the example above, not matching at one’s top pick does not diminish the chances of getting selected for their second pick. It allows participants to simply rank their choices without having to strategize how the system works. We used the DAA to assign Emergency Physicians their billet in our pilot project.
Another risk to safety is loss of anonymity. Commands want officers who are motivated to join their staff; thus, if commands can see officer rank lists, it is likely to influence their rankings. In our pilot, we kept the rank lists anonymous. Commands ranked their top picks without knowing the officer’s desires; similarly, officers submitted their rank lists anonymously.
A thick market is important to have, but it can lead to congestion. An uncongested market allows enough time for market participants to make satisfactory choices when faced with a variety of alternatives. Other than our system to assign Graduate Medical Education and Executive Medicine billets, the Medical Corps does not have a good central clearinghouse for job assignments. The Detailer and Specialty Leader assign some billets, others are vetted by the Corps Chief’s office, and others are considered by individual commands. Each of these steps is performed at an individual level and is time intensive; also, selection for one job is frequently done independently of another. All of these factors contribute to marketplace “unraveling.”
Consider a scenario where an officer is considering two positions: a leadership position with the fleet in San Diego and a Global Health Engagement (GHE) billet in New Zealand. While she would prefer the fleet job, she would gladly take the GHE billet. She applies for both and is offered the GHE position but must commit within a week. The fleet job will not be offered for three weeks, so she declines the GHE billet in the hopes of receiving the fleet billet. Unfortunately, she is ultimately not offered the fleet billet in San Diego. She then gives up in frustration and gets a flight surgeon position she did not really want. This undesirable unraveling can be prevented if a central clearinghouse uses an algorithm that processes the specified preferences in a single match day.
Results of the Pilot Project
Project results, including a pre-and post-intervention survey, are still being reviewed; however, some preliminary lessons can be described. We believe our overall goals were adequately addressed. First, the market was relatively thick – all officers saw the available billets. Second, the rules were transparent, and the participants knew the process for billet assignments. Third, commands had the ability to recruit the members they needed to accomplish their mission. Fourth, it is highly likely that this process led to the best net outcome.
Some participants expressed disappointment that they did not match with their top choice. They felt that the point of a DM was to match everybody with their top choice, but that is not the goal of a marketplace. The goal is to optimize outcomes. As long as there is variation in the desirability of billets, some participants will not receive their top choice.
One drawback was the effort involved for market participants. Most commands had not assisted in the selection process in the past, so efforts at recruiting and screening individuals was an unanticipated work requirement. In a similar way, Medical Officers previously communicated their desires only informally; now they had to submit a CV and complete interviews. However, the improvements obtained justify these additional efforts. As the process becomes more streamlined in the future, additional work should be minimized.
The present algorithm is modeled after the one used for the National Residency Match Program. While it worked for many of our assignments, there are important differences between the residency match and a military match. In their system, anybody can go to any position. This is not the case in the military; there are many officers who are constrained in their assignability by the Exceptional Family Member Program (EFMP) and by active-duty co-location requirements. Also, in the residency match program, it is acceptable for training positions to go unfilled and for medical students to not match. For the military, billets must be filled and officers must be assigned a job.
There are other military specific adjustments we would like to include in our algorithm. Of the eight billets that went unfilled in our match, all were OCONUS and many were operational. This might be correctable in the future by incentivizing less desirable billets. Also, a way to automate active-duty co-location and EFMP requirements would be beneficial.
Lastly, our process does not eliminate the potential for nepotism or talent concentration. It prevents Detailers from favoring individuals, but does not prevent commands from doing this. Ideally, nepotism at a local level would be more identifiable and correctable than nepotism at the Detailer level. There was some regulation in our project to prevent nepotism and talent concentration. For example, a command could only fill half their preferences from within their own command. For example, If a command had four available billets, at most two could be filled with officers already at the command.
As the Navy modernizes our billet assignment process, we should leverage the economic principles of marketplace design. Our pilot project, whose results we are still exploring, produced mixed results but is promising. The framework of a matching marketplace can be successfully applied to officer detailing, and may be improved through adjustments specific to the military environment.
The Non-Surgical Detailer position is available this upcoming winter and the Surgical Detailer position is available summer 2018. Here is the information on the positions:
Detailer Position Announcement
Non-Surgical Detailer position available winter 2018 and Surgical Detailer position open summer 2018. Seeking motivated LCDRs, CDRs, or CAPT from any specialty.
- Career enhancing: This is a high-visibility job that will give you career diversification.
- Make a difference: As a detailer assigning positions and providing career counseling, you have the opportunity to positively affect member’s lives and change policy at a high level.
- Work life balance. Ever thought about life without call or 24 hour shifts? This is a unique opportunity to help Navy Medicine and maintain optimal work life balance.
- Stay clinical. All 3 physician detailers stay clinically active. Many options for local or permissive TAD clinical experiences.
- Memphis! Live in Memphis–the home of the blues, the birthplace of Rock n Roll, and the biggest city in Tennessee. Urban offerings (museums, restaurants, night-life, zoo), history (Civil War, Music), outdoor activities (running, hiking, camping, road-biking, canoeing, etc.), and food and beverage options (BBQ, Jack Daniels) abound. Check out this website: http://ilovememphisblog.com/
- Kids? Live affordably in a gorgeous neighborhood with one of the best school districts in Tennessee. (http://lakelandk12.org/) (http://oakwoodlakeland.com/)
- Single? Exciting downtown Memphis is only 20 minutes away from Navy Personnel Command.
- Spouse? The job market is excellent for spouses in Memphis, Tennessee and home to several big employers including FEDEX and St. Jude Children’s hospital.
If interested in the Non-Surgical Detailer position, please contact CDR Richard Childers at 901-874-4046. This position will need to be filled in the next 2 weeks. For the Surgical detailer position, please contact CAPT Nanette Rollene at 901-874-4094.
Here are a few notes one of the Detailers sent out yesterday:
Delayed Order Release
Due to financial constraints, no orders have been released in the last several weeks. We acknowledge this is incredibly inconvenient to our constituents. Standby for more information, we will pass it as we get it.
Expired Projected Rotation Dates (PRDs)
Many officers have PRDs that are set to expire this summer. Officers with expired PRDs are attractive targets to place in high priority OCONUS and operational billets. Please get your extension requests in ASAP.
Officers planning to resign or retire should have their requests in 9 months prior to their requested detachment month. Requests turned in less than 6 to 9 months prior to requested detachment will be kicked back. There were several officers extended past their obligation because they did not send their request in on time.
I recommend reading CDR Schofer’s blog post entitled “How to Resign Worry Free.”
The earliest these can be submitted is 12 months prior to requested detach date.
Survey for Officers with a 2017 PRD
If your PRD was in 2017 and you accepted PCS orders or extended, please consider completing a one minute survey to assess attitudes regarding the billet assignment process among Medical Corps officers. The survey will close June 1st.
Last year we administered a survey of Navy Medical Corps officers to assess attitudes regarding the billet assignment process. We took measures to improve the process for billets assigned in 2017 and we are administering another short survey to measure improvement. The results, available at the end of the survey, will be briefed to leadership and made public. THANK YOU!
Naval War College
PERS needs people for the August 2017 Naval War College class. Applicants must have completed Joint Professional Military Education 1. They will consider breaking orders for appropriate applicants. Please see this blog post for a War College description by a current student.
As a recovering Detailer, I strongly encourage anyone looking to promote to O6 consider this position. Here is the announcement:
Family Practice and Operational Detailer position available now! Seeking LCDRs, CDRs, or CAPTs eligible to move in the summer of 2017. All specialties eligible.
- Career Enhancing: ever heard of a detailer that did not make CAPT? We haven’t. This is a high-visibility job that will give you career diversification.
- Make a difference: as a detailer assigning positions and providing career counseling, you have the opportunity to positively affect member’s lives and change policy at a high level.
- Take a break. Ever thought about life without call or weekend shifts? Remember those things called “3 day weekends” you had back in elementary school?
- Stay clinical. All 3 physician detailers stay clinically active.
- Memphis! Living in Memphis, the home of the blues, the birthplace of Rock n Roll, and the biggest city in Tennessee, is a blast. Urban offerings (museums, restaurants, night-life, zoo), history (Civil War, Music), outdoor activities (running, hiking, camping, road-biking, canoeing, etc.), and food options (BBQ, Jack Daniels whiskey) abound. Check out this website: http://ilovememphisblog.com/
- Kids? Live cheaply in a gorgeous neighborhood with one of the best school districts in Tennessee. (http://lakelandk12.org/) (http://oakwoodlakeland.com/)
- Single? Exciting downtown Memphis is only 20 minutes away from Navy Personnel Command.
- Spouse? The job market is excellent for spouses in Memphis Tennessee.
If interested, the POC is listed in this Detailing Position Announcement.