Podcasts
The Top 5 Critical FITREP Mistakes
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.
2nd Step to Financial Freedom – Get Properly Insured
Having adequate insurance is a fundamental part of your overall financial plan and the 2nd step to financial freedom after establishing an emergency fund (perhaps it should even be 1st). It is also something that most people struggle with, as there are innumerable types of insurance with many options to choose from. At it’s most basic, insurance is a method to transfer risk from you to an insurance company, and you should only pay to transfer risks that you are not willing or able to shoulder. While insurance companies are happy to insure everyone and everything, in general you should only insure against large losses. Below is one man’s attempt to treat insurance with a “KISS” (keep it simple, stupid) approach. This post will discuss insurance that you probably need, insurance you might need, and that which you probably don’t need.
TYPES OF INSURANCE YOU PROBABLY NEED
If you cannot afford the costs involved in any life scenario, then you should probably insure yourself against it.
Disability Insurance
While an emergency fund and the Navy’s disability policy can “self-insure” you against short-term disability, you may need help in the event of a long-term disability unless you are wealthy enough that you can make up the difference between your military pay, including all physician bonuses, and your disability payments, which will not reflect the higher pay of a physician. Most physicians probably rely on their higher pay, and would be pretty disappointed with the Navy and VA payments in the event of 100% disability, in which case you’d get approximately your annual/monthly basic pay.
Typically, you should obtain enough coverage to replace 60-70% of your income up to the age of 65 in the event of total disability. Ideally, the policy will cover your specific specialty as a physician, what is called “own occupation,” and will not rely on you finding alternative means of employment, such as working in a different specialty. You will also want coverage if you can only work part-time. Key components of the ideal policy include:
- Non-cancelable – they can’t cancel your policy or raise your premiums
- Guaranteed renewable – no medical exam is required to renew
- Residual benefit protection – pay you part of your benefit, or “residual benefits” if you are partially disabled
- Cost-of-living allowance – the amount you are paid is adjusted for inflation
If you think the Navy/VA disability payments would be inadequate, look for a private policy, which may be expensive and difficult to find as an active duty physician. After years of searching, I was able to get up to $2500/month of supplemental coverage from the American Medical Association. In addition, a private company called DI4MDs.com was able to get me the level of coverage I needed, although it was pretty expensive (but not as expensive as being under-insured in the event I’m disabled).
Try to reduce the expense by lengthening your “waiting” or “elimination” period. The waiting/elimination period is the amount of time you have to wait after becoming disabled until your disability payments begin. If you have a substantial emergency fund, you can lengthen your waiting/elimination period and lower your premiums. In addition, I figured it would take at least a year for the Navy to separate me if I was significantly disabled. If you don’t have a large emergency fund or you feel the Navy will move fast in the event you are disabled, you may need a shorter waiting/elimination period and will likely pay higher premiums.
Homeowner’s Insurance
You need homeowner’s insurance to protect the structure of your house, its contents, and to insure against injuries to other people or damage to other people’s property. Make sure that the contents of your home are covered for “replacement cost” and not “actual cash value.” For example, replacement cost coverage will give you $800 to replace the 3 year old laptop that was damaged, while actual cash value would only give you the $200 it is worth after 3 years. In addition, you will likely have to purchase a “floater” to cover any high-value items, such as jewelry or expensive art.
Renter’s Insurance
If you rent, you’ll need renter’s insurance to protect your belongings, but it also offers liability protection, similar to homeowner’s insurance.
Auto Insurance
You need auto insurance in case you have a serious accident and damage your car, injure yourself or others, or damage someone else’s property. Lower your rates by having a deductible on the policy that is as high as you can comfortably afford, and carefully evaluate how much collision and comprehensive coverage you need. If you are driving an older vehicle that is not worth a lot of money, paying for this coverage may not make sense.
Umbrella Liability Insurance
Umbrella liability insurance protects you in case you get sued and adds liability coverage on top of your homeowner’s, renter’s, and auto insurance. It will come in handy if your dog bites someone and they develop necrotizing fasciitis, the mailman slips and falls on your front porch and can no longer work, or a neighborhood child drowns in your pool. It is typically sold in $1 million increments and is relatively inexpensive. A $1 million dollar policy will typically run $150-300 per year. As a physician, you should have AT LEAST $1 million of coverage, and should consider up to twice your net worth.
What if you are early in your career and have very few assets? You should still have umbrella liability insurance as future wages can be garnished in some judgments against you.
TYPES OF INSURANCE YOU MIGHT NEED
Professional Liability Insurance
If you are practicing medicine outside of the Navy (moonlighting), you need professional liability insurance. (If you don’t moonlight, you don’t need it.) This insurance will cover attorney fees, expert witnesses, court costs, costs of gathering evidence, and settlements in the event you are sued.
There are two types of policies, “occurrence” and “claims-made.” Claims-made policies only cover your liability if a claim is made before the policy ends. With this type of insurance, when you leave a job you need to purchase “tail coverage” that extends your liability. Tail coverage can be expensive, and before you take a job moonlighting you need to make sure you know who is going to “pay the tail.” Occurrence policies are more expensive (and therefore less commonly offered) because they cover your liability in perpetuity and do not require a tail.
Life Insurance
“More money is wasted on life insurance than probably any other insurance product…It cannot be overemphasized that cash-value life insurance is probably one of the biggest scams around.” – Paul Sutherland in the AMA Physician’s Guide to Financial Planning (2008)
If you were to die, would anyone suffer financially? If the answer is “no,” then you don’t need life insurance. If the answer is “yes,” then you need life insurance, and probably a lot of it until you build your investment portfolio.
There are two types of life insurance. First, there are products that combine insurance with an investment account, often referred to as “cash-value” or “permanent” life insurance. Many insurance agents and companies (including USAA in my experience) will try to sell this, but it is probably not the kind of insurance you need. It does have some tax advantages, but the downside of these policies is that the insurance agent/company who sells them collects high fees. In addition, early premiums go mainly toward sales commissions and other expenses and not into your investment account.
The second type of life insurance is “term” insurance. It provides a death benefit only and does not build any cash value or serve as an investment. This is likely the only kind of life insurance that you need, and this is the type that Servicemembers Group Life Insurance or SGLI is. To quote again from the AMA’s financial planning guide, “I cannot emphasize enough the importance of sticking to simple, unencumbered term life insurance – it fits 99% of insurance needs.” It is less expensive than cash-value/permanent policies and you can take the difference and invest it in a retirement account or other low-cost investment vehicle. You don’t need an insurance agent to purchase this and should simply try term4sale.com, selectquote.com, accuterm.com, insure.com, or other similar websites. Both USAA and Navy Mutual Aid Association (and other companies you can find in Navy Times) offer military-focused term life policies.
When you buy term insurance, ensure that it is renewable without a medical examination. You can also consider decreasing term insurance, where the death benefit progressively decreases. As you age, the need for life insurance typically declines as dependents age and your investment portfolio grows. Eventually you will need no life insurance at all, which is why many arguments for “permanent” life insurance should fall on deaf ears.
Long-Term Care Insurance
Sometimes called “nursing home insurance,” this is usually purchased by people over the age of 50 to pay for nursing or at-home care. If you are under 50, you should probably purchase disability insurance instead of long-term care insurance.
The rates and terms of these policies are highly variable, and whether you want to get one is an individual decision. The earlier you purchase it, the cheaper it is, but the total money you’ll pay out over the life of the policy is obviously higher. If you are a successful investor, as a physician you will probably have enough assets to self-insure in the event you need prolonged care, so I would suggest that most will not need this, but circumstances and goals obviously vary, so it is something to consider. If it is important to you that your nest egg is passed to your heirs, you may want to consider this insurance so it is not passed to a nursing home instead.
Flood Insurance
Homeowner’s and renter’s insurance do not cover flood damage. To find out if your home is at risk of a flood, go to floodsmart.gov. There you can also find out information about the government’s low-cost flood insurance programs.
Earthquake Insurance
If you live in an area at risk for earthquakes, you’ll need earthquake insurance in addition to your homeowner’s insurance. California’s earthquake website, earthquakeauthority.com, is a good place to start.
TYPES OF INSURANCE YOU PROBABLY DON’T NEED
Supplemental Medical/Health Insurance
TRICARE has got you covered here, and there is no need to consider supplemental insurance until you retire.
Life Insurance for Children
While you will be sad if one of your children dies, you do not rely on his/her income; therefore you are unlikely to need life insurance for children. The same thing is likely true for a spouse/partner who does not have a job, unless you would need money to replace the childcare he/she provides.
Rental Car Collision Insurance (Loss Damage Waiver)
They always ask if you want collision insurance or a “loss damage waiver” when you rent a car, but a lot of auto insurance policies automatically cover your rental cars. In addition, some credit cards provide this too if you use their card to pay for the rental car, which is one reason you have to use your government credit card for officially authorized rental cars. Make sure you find out if your policy or credit cards have this before you step up to the rental car counter and are put on the spot.
Flight Accident Insurance
If you need life insurance, buy it. Don’t buy insurance on a whim when purchasing tickets in the off chance that your plane goes down.
Travel Insurance
This is a common credit card benefit when you use them to pay for your trip, so check with your credit card company. Even if you don’t have it, it is unlikely to be worth your money for domestic flights.
Credit Protection Insurance
This is designed to protect your credit by insuring your credit card or mortgage payments in the event you become unemployed, disabled, or dead. If you have life or disability insurance, this is probably unnecessary.
Extended Warranties
Most products that offer extended warranties are not costly enough to insure with an extended warranty. If the new TV happens to break shortly after the warranty expires, you’ll probably be able to afford a new one. Most of these offers are a waste of your money.
GENERAL INSURANCE ADVICE
Insurance companies occasionally go under, so you want to make sure that you only get insurance from quality companies with strong financials and that you diversify your larger policies. You can find information on the finances of insurance companies from AMBest.com, FitchRatings.com, Moodys.com, and StandardAndPoors.com (NOTE: most of the sites require you to register to access their ratings). For example, if you need $2 million in life insurance, you should strongly consider diversifying and getting 2-3 different policies from various companies.
1st Step to Financial Freedom – Establishing an Emergency Fund
Bad things happen to good people. Houses burn down or flood. Cars get totaled. Physicians are served unexpected divorce papers. Extended family members get huge medical bills that they can’t pay. You need to prepare for these unlikely but unanticipated events by keeping 3-6 months of living expenses in conservative investments that you can access in an emergency.
While most people recommend you accumulate an emergency fund, nothing is ever straightforward in the world of finance, and even something as bread-and-butter as an emergency fund can be controversial. Below are the aggressive and conservative approaches to establishing an emergency fund.
The Conservative Approach
There are many places you can park your emergency cushion. Savings or checking accounts are Federal Deposit Insurance Corporation (FDIC) insured and offer immediate access to your money, even via ATMs. The downside is that the historic yield on these investments usually does not keep up with inflation, so you lose purchasing power over the long haul. Money market mutual funds are the most recommended place to park your emergency reserves as they offer higher returns and allow you to write checks above certain amounts (commonly $250 or $500), giving you immediate access to the funds when you need them. Unfortunately, the yields on money funds are at a historical low and not consistent with their approximate 3% historical average that would normally keep pace with inflation. Keeping emergency money in certificates of deposit is probably not a great idea, as you’ll pay a penalty if you access the money early.
Not all savings accounts or money funds are the same, and if you shop around you can find a better deal. For accounts offered by banks, check bankrate.com. As I write this, the yield on savings and money market accounts ranges from 0.05% to 1.01%. For money market mutual funds, which are not FDIC insured but are almost as safe, check mutual fund companies. Commonly recommended company websites include fidelity.com, schwab.com, tiaa-cref.com, troweprice.com, or vanguard.com (my favorite). Important things to look for are the minimum initial investment, the smallest amount you can write a check for, and the expense ratio (the lower the better). If you find yourself in a higher tax bracket, usually 33% or higher, it may make sense to use a tax-exempt money market fund that invests in tax-free state and municipal bonds. These tax-exempt funds may offer a higher after tax return, and some are targeted to the residents of particular states and offer state tax benefits as well. The mutual fund companies can usually help you decide which of their products is best for you.
The Aggressive Approach
The aggressive approach is to keep a smaller amount in reserve, 1-3 months of living expenses for example, and invest it more aggressively. You could keep 1/3rd of it in a money market fund, but the other 2/3rds could be invested in a stock or bond fund or some combination of the two that will yield a higher return. This will allow your emergency fund to grow as your income grows, possibly reaching the recommended 6 months of living expenses or more. If you need more cash than what is in your emergency fund, a physician can usually borrow the money by using a home equity loan, for example, or a credit card. Credit cards, obviously, have higher interest rates, but this is an aggressive approach and you probably won’t have to borrow any money at all.
What Should You Actually Do?
Only you can decide what is right for you. For example, as Navy physicians we all have full medical insurance for our whole family through Tricare, and have as much job security as any physician can have. I’m not getting fired (or at least I don’t think I am). As a result, my emergency fund usually resides in the low end of the 3-6 month range, as there are very few emergencies I expect to have to deal with. On the other hand, if I was a civilian and worked as an independent contractor, provided my own health insurance, and felt that my contract could be reduced or eliminated at any time, I’d probably have 6 months of living expenses (and maybe more) providing a more substantial cushion.
Whether you take a conservative or aggressive approach or somewhere in between, what is clear beyond a doubt is that you and your significant others need to come up with a plan for emergencies that makes sense for you and allows you to sleep at night.
Sailor of 2025 Talent Management Initiatives
There are some exciting and interesting initiatives underway to modernize the Navy’s personnel system. There have been many articles on this in Navy Times. Here is one article recently released by the Military Officers Association of America.
In addition, here are some slides that describe this initiative:
The changes that physicians should be aware of, some already finalized and others representing potential changes, are:
- Pay and bonus changes that would reward individual talent rather than treat everyone the same.
- A removal of promotion zones. No longer would records be stamped as below-zone, in-zone, or above-zone during promotion boards. This would switch to a system that rewards talent and milestones rather than longevity. It would allow those that progress faster to promote faster and no longer have to “wait their turn” as well as remove the stigma that some feel is associated with being above-zone.
- Expansion of opportunities to diversify your career. Examples include an expansion of the career intermission program and fellowships providing officers with the opportunity to spend some time in civilian industry so that they can bring best practices back to the Navy.
- An information technology (IT) investment in a new, more transparent personnel management system. Ideas I have heard mentioned include eliminating all of the various computer systems that exist and consolidating them into one so that you don’t have to update your record in 20 different ways. An assignments system has also been mentioned that would allow officers to see all the billets available and apply for the ones that they want, giving commands the ability to pick which officers they want.
- Improved co-location policy. I have no details on this one, and right now I feel the detailers do a pretty good job co-locating dual active duty couples, but others may disagree.
- Changes to the physical fitness assessment/body composition assessment (PFA/BCA), which were detailed in this NAVADMIN. This includes expanded fitness center hours.
- Changes to the maternity leave policy, detailed in this NAVADMIN, and expanded child development center hours.
Keep in mind that while some of these changes have been released already, like the PFA/BCA and maternity leave policies, the rest are works in progress. I think it is interesting, though, to see that the DoD and Navy leadership are interesting in modernizing our personnel system and management. As a detailer who writes orders on a DOS-based system, I can assure you that modernization is sorely needed.
FY16 O5 Promotion Board Takeaways
Now that the FY16 O5 promotion board results have been released and I’ve had a chance to review a number of officer records, here are my O5 promotion board takeaways. If you’d like to review the statistics, click here:
https://mccareer.org/2015/07/18/fy16-cdr-promotion-board-statistics/
Promotion Board Takeaways
If these things happen to you, you are very likely never going to promote to O5:
- 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 GME. There were people who promoted while in GME, but those lucky few broke out in large competitive groups before or during GME. Those who have non-observed (NOB) fitreps before the board, such as those in full-time outservice training, tend not to promote.
- 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 while you are still in GME, and is worsened if your residency is long.
- Never getting a competitive early promote (EP) fitrep. Many officers who fail to select for O5 have never had a competitive EP fitrep as an O4. This can be because they are stationed places without competitive groups and get 1/1 fitreps, or it can be because they were in a competitive group and did not break out and get an EP.
- 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 thing 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 you don’t have a photo in your current rank, 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? In general, the officer who promotes to O5 is:
- Board certified.
- Finished GME early enough that they had time to break out with a competitive EP fitrep as a staff physician.
- 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.
Moonlighting in the Navy
It’s July 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 podcast 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.
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 $18,000/year in the TSP and $5,500/year in your IRA (based on 2015 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 $53,000/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. For a great discussion on these two options, go to:
http://whitecoatinvestor.com/sep-ira-vs-solo-401k/
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.
Contract Pitfalls
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. 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:
Basic Anatomy of a FITREP
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 that was just released a few months ago.
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 FITREP instruction:
BUPERSINST 1610.10D – Navy Performance Evaluation System
O5 Promotion List Released
Below this message is the O5 promotion list. For those that were selected, congratulations. Now that you are a CDR(s), you should strongly consider mixing your career up a little. No matter what you do for the next few years as a junior CDR, you’re likely to get a promotable (P) on your fitreps if you are in a competitive group. This fact makes it a great time to PCS, moving overseas or to a senior operational role if you haven’t done those tours yet. It also makes it a great time to apply for a fellowship, go to a War College, take on a job that you will enjoy but will get you 1/1 fitreps that could hurt you later in your career, or pursue anything else you can think of that is rank appropriate. Then after you spend a few years doing this, you can return to a command, try to get a senior leadership role and competitive fitreps, and give it your best shot to promote to O6.
If you did not promote, it is time to regroup. See my June 21st post entitled “You Failed to Promote…Now What?” Keep in mind, that most physicians are offered continuation until year 20 as a LCDR, so you likely have a few more chances to promote.
Once I have some time to analyze the O5 board results and get some statistics, I’ll do a more detailed post with O5 promotion board takeaways.
Introduction to Medical Corps Special Pays
This is my first videocast of a lecture I gave to the Emergency Medicine residents at NMC Portsmouth a few weeks ago. I was surprised by how many questions there were about special pays. I think it is a topic that is mundane to those of us that have been in the Navy for a while, but can be quite a mystery to new Medical Corps officers. As I learn how to videocast I’m sure the content will improve, but aside from one place where I said “January” instead of “July” I think it turned out well. I hope junior physicians enjoy this introduction to the world of Medical Corps special pays.
Could a Master’s Degree Get You Promoted?
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 in person at remote sites via video conferencing. You have to have 2 years of time-on-station left at your current command, so you have to apply to start right after you get to a command or get a new set of orders. In addition, your CO has to sign a letter stating that you’ll get the time to attend classes once per week for 8-9 hours and that you are not slated to deploy. You can deploy once you start the program, but you can’t be on the hook when you apply.
- Use Navy Tuition Assistance (https://www.navycollege.navy.mil/ta_info.aspx#eligibility) to pay for a degree. The tuition rates they pay will not completely cover more expensive degrees, but every little bit helps.
- 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.
- 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 (http://www.physicianleaders.org/education/programs/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.
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