Debt, College, and Discretionary Spending

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Here are the slides I used to record this episode of the podcast:

Debt, College, and Discretionary Spending


Here’s the screencast:

Tips to Build Your Career During Residency

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Here are the slides I used for this episode of the podcast:

Tips on Building Your Career During Residency

The New Medical Corps Career Progression Slide – What Does It Mean to You?

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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.


Example Assignments

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.

Playing the Game and Managing Your Military Career

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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:

Playing the Game – Managing Your Military Career

FY21 Promotion Boards – What are They Looking At and How Can You Get Ready?

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Here is a screencast/podcast of this updated lecture as well as the PDF of the slides I used:

FY 21 Promotion Boards Slide Deck

FY20 Promotion Boards – What are They Looking At and How Can You Get Ready?

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I gave this talk to the medical staff at NMC Portsmouth a few weeks ago, and I finally got around to recording it for all to enjoy…

Here is a PDF of the slides:

FY20 Promotion Boards – What are They Looking At and How Can You Get Ready

Here is a video screencast you can watch in just under 30 minutes:

How to Evaluate the Promotion Potential of a Billet/Position

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Recently I advertised the USUHS Commandant position. A reader asked:

Any thoughts on whether you think this is a position that would make an O5 competitive for O6?

This is a common issue. A position is advertised, but you want to know if it will help get your promoted to O5 or O6 if you take it. Here is how I’d evaluate that situation.

First, you need to contact the incumbent in that position now, if possible. You’re going to need information that they have.

Now that you’ve contacted that person, you need to ask them some questions:

  • Did they or anyone before them promote to O5/O6 while they were in the position or shortly thereafter? In other words, has taking the position led to promotion for those who’ve already done it? If the answer is yes, that is telling and indicative that the position advances people’s careers. If the answer is no, you should probably look elsewhere for a career advancing position.
  • How large is their competitive group on their fitreps? You want a position with a large competitive group so that you can perform well and break out to the right with MP and EP fitreps. Competitive EP fitreps are probably the #1 most important ingredient for successful promotion, so if the position has a small competitive group or leads to a 1/1 fitrep, it would be a mark against that position’s potential to get you promoted.
  • Were they able to get EP fitreps? They might not tell you this, but if they are willing to give you this info it can help you gauge the potential for you to get EP fitreps while doing the job.
  • What do your mentors think about you taking the position? We all need mentors, and I always ask mine what they think when a potential position is in my crosshairs. If they don’t think it is a good idea, I usually pass on it.

That’s it. Those are the things I’d look at when trying to evaluate whether or not a position will help you get promoted. Most of the information needs to come from the incumbent or people who have previously done the job.

What Should You Do If You Didn’t Promote?

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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 stay in as a LCDR for 20 years, and I personally know of people who got promoted their 9th look!