The Book

MCCareer.org – The Book – Chapter 1 – What We Wish We Had Known

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By Joel Schofer, MD, MBA, CPE, Paul Roszko, MD, Mickaila Johnston, MD, and Wendy Schofer, MD

As we look back at our Naval careers, these are things we wish we had known early in our career.

Medical School

  • Going to the Uniformed Services University is great, but a seven year commitment is a long time unless you are 100% certain you want to do 20 years in the Navy (or will finish your time in the Reserves).
  • If you want to improve your chances of matching in the internship/residency you want, you need to do everything you can to rotate there during your fourth year and impress them. Getting a publication or two before applying will also increase your competitiveness.
  • If you ever fail a body composition assessment (BCA) or physical readiness test (PRT), your ability to promote to anything above LCDR will likely end for a five year period. For this reason, you need to make diet, exercise, and physical fitness part of your lifelong routine and NEVER fail a BCA or PRT.
  • Make sure you save copies of your paperwork with the Navy, starting with the reimbursements/receipts during medical school and every Leave and Earning Statement (LES), which is the military pay stub. Sometimes errors are made and the only way to prove it is with your documentation.
  • Do everything you can to live on the money you get when you’re in the Health Professions Scholarship Program (HPSP) and avoid taking out additional student loans. You want to make sure that you graduate medical school with as little additional loans as you can.
  • Build wellness into your routine NOW. Take the stairs, make healthful food choices, drink water and don’t even start on diet sodas, build workouts into your schedule, and prioritize sleep. No one will do this for you. And PRTs are not workouts. You need to be active throughout the year, not just during PRT season.

Internship

  • My Navy Portal is the centralized website that the Navy is developing as a one stop shop for all on-line websites you’ll need to access. In a similar manner, the My Navy Career Center is the one stop shop for any personnel questions you have. It can be reached at 833-330-MNCC or 901-874-MNCC (DSN 882-5672). You can also e-mail them at askmncc@navy.mil or live chat.
  • If you want to be wealthy, you should save 20-30% of your gross (pre-tax) income for retirement. This is separate from any other savings for a house, cars, college, or anything else you are saving for. The 20-30% is exclusively for retirement. Add that to a military pension, and you’ll have options to retire early if you want to.
  • Get a better understanding of finances and how the military retirement system works. Under the old retirement system, you received no contributions to your retirement unless you made them yourself. Familiarizing yourself with the Thrift Savings Plan (TSP) is even more important now with the Blended Retirement System (BRS) as the government now matches up to 5% of your base pay. This is free money, and everyone should know how to go into myPay and allocate a portion of their pay to their retirement account in the TSP.
  • When investing in the TSP, it is easiest to only allocate a percentage of your base pay because it is more stable/predictable (i.e. you know how much is coming out of your paycheck and how much is going into your retirement account). Your special pays/bonuses will change more frequently, which can make it harder to ensure you are allocating enough money to maximize your yearly contributions.
  • The Roth TSP is probably the better choice over the traditional TSP because your overall tax burden is relatively low, and certainly less than it would be if you were a full time physician outside of the military.
  • If you do not know anything about investments, use of the Lifecycle funds is the easiest way to get started. They are the default option in the new BRS.
  • If you are interested in research, most commands with graduate medical education (GME) programs will have a research office that holds sessions on how to get started conducting research. They can also help you secure external funding, however there are Surgeon General (SG) funds that are distributed through the Navy Medicine regions each year that you can apply for. Having an approved research proposal is usually the only barrier to getting access to these funds.
  • Once you have completed your research project and wish to present your findings, you will need to obtain approval from your command before the manuscript, abstract, or poster is submitted to a conference or medical journal. You cannot publish anything in your official capacity without getting command approval and including the required disclaimers. Even presentations to the public need approval unless the audience is purely military.
  • At some point during internship, you are going to want to download the Promo Prep, read it, and start updating your officer record, including getting an officer photo in your record. The sooner you can learn about this and get your record correct, the better. Some interns with prior service get considered for promotion to LCDR very early in their careers, so having a correct officer record that is ready for promotion boards should be a major goal of yours during the early phases of your Naval career.
  • Create a CV and military bio and update them monthly for the rest of your career. You can find examples here. If you are interested in an academic career and promotion, you will need an educator’s portfolio as well. Since you will want to put all of your presentations in it and collect audience feedback/evaluations, the sooner you start doing this the more robust your portfolio will be when it is time for academic promotion.
  • On a monthly basis, log on to SWANK, the Navy’s one-stop-shop for training requirements, and complete any training assigned to you.
  • Learn the five critical fitness report mistakes and make sure none of them ever happen to you.

 

General Medical/Undersea Medical Officer and Flight Surgery Tours

  • A non-medical reporting senior may not understand how to write your fitness report. The same can be said about inexperienced medical reporting seniors. You need to learn this yourself.
  • Never let yourself get anything other than an Early Promote (EP) when you are getting a “one of one” fitrep.
  • Always try to be above your reporting senior’s average.
  • You may find yourself deploying for the first time. Make sure you read your orders. You may be able to break your lease and store your household goods and vehicle while you are gone. You should also consider investing up to $10,000 into the Savings Deposit Program (SDP), which provides a 10% guaranteed return on your money while you are deployed (and for 3 months after you return). This process cannot be initiated until you have had 30 days boots-on-ground and will need to be coordinated through the finance office where you are deployed. Also check to see if you qualify for the Combat Zone Tax Exemption (CZTE), which allows all of your earnings while deployed to be tax free. While entitled to the CZTE, any contributions to your Roth TSP are 100% tax free. If you can afford it, you can also contribute above the usual $19,000/year limit (in 2019). Once you have maximized your contributions to your Roth TSP, anything above $19,000 has to go into your traditional (non-Roth) TSP account.

Residency

  • Travel for temporary additional duty (TAD) can very easily get screwed up. You are going to have to get familiar with the Defense Travel System (DTS) early on, so make sure you are really nice to the people in your travel office. They will have to teach you how the system works and what paperwork is required for you to travel.
  • Be sure your Department Head and administrative assistants know your travel intentions well in advance so they can request the appropriate funds for their yearly budgets.
  • Submit your DTS authorization request well in advance of your travel (> 90 days is preferable) because there will be mistakes or missing documentation you didn’t know you needed.
  • Make sure you keep all relevant receipts from your travel (including SATO receipts for your airfare, hotel receipts, rental car receipts, registration for conferences, and parking receipts) and scan and upload them into DTS when you submit your voucher.
  • If someone else wants to pay for you to travel, make sure to check with your legal office so you obtain the proper approvals.
  • For all no-cost or permissive TAD travel, make sure a DTS request is entered and closed out after the travel. This is your way of documenting to the command where you went, for how long, and why you may have missed any command-wide required activities (e.g. urinalysis testing).
  • Contact your Specialty Leader and Detailer 9-12 months ahead of your graduation date to start negotiating the orders for your utilization tour, but realize that most assignment decisions don’t get finalized until after the GME Selection Board results are finalized in January. Also realize that you are likely going to get what they give you when it comes to your first staff assignment. You may have some wiggle room to negotiate, but the most effective response to wherever they want to send you is most likely to be “Yes, Sir/Ma’am.” Bloom where you are planted.
  • If you plan on making the Navy a career and having a family, it is probably easier to go overseas right out of residency, if possible. The more senior you get in the Navy, the harder it seems to be to go OCONUS. Kids get older and more tied to friends/schools. Go OCONUS right away and get it over with.
  • Start your special pays request before you leave your GME site. You may be going somewhere without expertise in Medical Corps pay issues.
  • The Navy will not pay for your state medical licenses, but it will pay for your board examinations and Maintenance of Certification. This process is easy to screw up, though, and this most commonly happens when you do not get advance approval to take the test or cross fiscal years. The instruction for board certification reimbursement can be found on the Useful Documents tab on MCCareer.org.
  • If you want to do a fellowship, discuss this with your Specialty Leader probably two years before you intend to apply. They can give you information about the likelihood you can get training in that specialty and put you in touch with the Specialty Leader of that subspecialty (if there is one). You should follow any advice that you are given to make yourself competitive for the fellowship and apply for the fellowship even if you are told that there will not be any fellowship spots that year. Things change and sometimes you might be selected as an alternate and get the opportunity to apply for your fellowship if not all other fellowship positions wind up being filled.

Fellowship

  • If you are in a full-time outservice (FTOS) fellowship, you will probably get non-observed (NOB) fitness reports. Although non-observed, you can still enter comments in block 41. Make sure you put all of your achievements and accomplishments in it.
  • Because you will likely be receiving NOB fitness reports, you need to realize that they can have a dramatic effect on your ability to promote. Going into a promotion board with NOB fitreps puts you at a disadvantage, therefore, the best time to do a fellowship is after you are selected for promotion to your next rank. That said, you often have to take the fellowship whenever it is available. If you do so, just realize that it may delay your promotion by a few years.
  • Make sure you figure out if it would be advantageous to take a retention bonus (RB) before you start your fellowship. This whole issue is explained in this blog post.

Utilization Tour

  • Find the special pays coordinator at your command and track your special pays application to completion.
  • Your first and only initial job is to pass your boards. After that…
  • When your senior leadership asks you to do something, the answer should be “Yes, Sir/Ma’am.” If it isn’t, it’ll hurt your career.
  • When they need volunteers for something, you should volunteer. If you don’t, it’ll hurt your career.
  • If they need you to deploy, deploy without question or argument. If they need a volunteer, volunteer. If you don’t, it’ll hurt your career. Do you see a pattern here?
  • If you trained in a civilian program and are new to the military, you should strive to take some military courses that can help you understand the core principles behind battlefield medicine and what is being taught to Corpsmen and medics. Familiarize yourself with the concept of the Joint Trauma System (JTS), Committee on Tactical Combat Casualty Care (TCCC), and the JTS Clinical Practice Guidelines. Taking the Basic Medical Department Officer Course (BMDOC) on-line or a TCCC course early in your career is a good idea.
  • If you are notified you are deploying, there are a few things you should do. First, find out what type of deployment it is. If it is associated with your platform or you will deploying as an individual augmentee (IA, https://www.public.navy.mil/ia/Pages/index.aspx), then you’ll be staying at your current command. If you are deploying in a Global Support Assignment (GSA) then you will be receiving orders to PCS from your current command to a new one, likely Expeditionary Combat Readiness Center (ECRC) in Norfolk, Virginia. This will be your military command while deployed, and then you’ll get new orders to PCS somewhere else (which could be back to your original command) when you return.
  • If you have an office phone with a DSN number, set it up to forward calls to your spouse/significant other’s mobile phone before you deploy. This allows you to call the DSN number from a landline at the location where you are deployed and get forwarded to your loved one’s phone.
  • While you may think that there is no way that you are staying in for a long-term Navy career, don’t ever cross opportunities off the list. It may wind up being an alternative option that you can use in the civilian world or it will be a good stepping stone for your Navy career.
  • Build in time for your family. Give the Navy your all while you are at work, but when you come home, be present with your family/friends/pets. The Navy needs strong officers, but it does not *love* you. Your family loves you and needs you.

Mid-Career (O4/O5)

  • Get a mentor. Or two. Or three. Figure out who or what you want to be in five years, and seek out those people. Ask them for advice and mentorship.
  • What do you want out of your Navy career? No matter how much you enjoy the Navy, the Navy will not love you back. You need to ensure that there is a balance between your inputs into the career and the yields. No one says you have to stay in past your obligations – the best approach may be to stay in as long as it is fun.
  • Transitioning to the reserves is an option, but the grass is not always greener on the other side. If you are considering departing active duty for the drilling reserves, touch base with someone who is currently drilling (and not just a recruiter) to find out the realistic obligations and community needs.
  • You need to get some major collateral duties. Until the system changes, it is usually your leadership duties in addition to your clinical duties that allows you to stand out when they are ranking people for fitness reports. If you’d like to see a list of appropriate collateral duties, here they are.
  • You should try to get in the Advanced Medical Department Officer Course (AMDOC). There is a misconception that it helps you promote, which it really doesn’t. What it does is teach you all the things you need to know to be a developing and effective leader in the Navy.
  • If you are in the reserves by this point, say yes to opportunities. You will stand out very quickly in your career progression by taking leadership courses and diverse annual trainings, as well as mobilizations that arise.
  • Think about moves – when is a good time to volunteer to move to make it easier for your family. Some PCS/orders are not foreseen, but volunteering at particular times can give you a leg up in planning for family relocations at better times (e.g. at natural transition times in school, like between elementary and middle, or between middle and high).

Senior Career (O5/O6)

  • The Navy should be fun. If you don’t like your job, change it. The Navy lets us change jobs more than most civilian settings would, and you don’t have to start over in a new organization.
  • If you’re interested in being an Executive Officer (XO) or Commanding Officer (CO), you need at least one successful tour in a senior job. These usually include being a Director, Chief Medical Officer (CMO), or Medical Executive Committee (MEC) President at a military treatment facility or Officer-in-Charge of a clinic. You also need to get your Executive Medicine Additional Qualification Designator (AQD).
  • You should try to complete Joint Professional Military Education I by the time your O6 promotion board occurs. It is among the more impactful and beneficial educational paths you can take in Navy Medicine.
  • Unless you really enjoy them, you should seriously consider stopping any collateral duties, committees, etc. that no longer show up on your fitness report. If it isn’t important enough to show up on there, it isn’t important enough to do. There are only 168 hours in the week.

Tell Me What You Wish You Had Known

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The first chapter of the planned MCCareer.org book is “I Wish I Had Known”. Let’s write it!

Reflect on your career and tell me what you wish you had known when you were younger, more junior in rank, and (in my case) had more hair. You can tell me using the contact me tab, Tweet me, Facebook me, contact me on LinkedIn, or post it in the comments below this post. If I like your suggestions, you’ll get credited in the chapter. In fact, if you contribute enough you might become a co-author!

MCCareer.org – The Book

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The Navy does an okay job helping physicians plan their careers, but in my opinion this preparation can be a lot better. This is why I created Joel Schofer’s Promo Prep and subsequently MCCareer.org. By the time you progress in your Naval career and learn everything you need to know, it is often too late. Therefore it is the responsibility of those who are senior and have already learned this information to teach it to the next generation of Naval physicians before it is too late.

The modern adult learner has more educational methods at his/her disposal than ever before. Whether you like social media, such as Twitter or Facebook, prefer to listen to podcasts in your car while you are driving, or like traditional methods of learning, such as reading articles, you can find one of these sources to learn about almost any topic you can imagine. Yet even though traditional books seem to have fallen out of favor during the rise of social media, there is still something reassuring about reading a book. Putting information in a book validates it and provides some degree of credibility. So, despite the fact that blogs have partially replaced books and the MCCareer.org blog has taken off, I think a book that discusses Navy Medical Corps career planning will still be well received and a valuable resource, which is why I’m creating one. I hope you enjoy it, benefit from it, and, frankly, help me create it. Here’s how I see this going down…

Take a look at the chapter list below. If there is something on it that you feel particularly qualified to write, let me know. Just in case I get a lot of interest, make sure to tell me what makes you qualified. Together we’ll use anything that is already on this site and we’ll turn it into a chapter, posting it on the site so others can read and use it.

If you think there is something we’re missing, let me know.

No one will make any money on this. It’ll just be a useful resource for anyone who wants to use it, and we’ll have it available on the blog as well as downloadable in PDF format. Maybe once it is all done we’ll create a real book in print or e-book, but for now I’m planning just putting it on the blog for free.

Chapter List

  1. Introduction
  2. I Wish I Had Known
  3. Pathways to Becoming a Naval Physician
  4. Career Paths & Progression
  5. Women in Navy Medicine
  6. Minorities in Navy Medicine
  7. Naval Leadership & Mentorship
  8. Pay & Reimbursable Expenses
  9. Personal Financial Planning
  10. Moonlighting
  11. Graduate Medical Education
  12. Other Educational Opportunities
  13. GI Bill
  14. Leadership Opportunities
  15. Preparing for Important Interviews
  16. Fitness Reports
  17. Personal Awards
  18. Officer Service Records
  19. Promotion Boards
  20. Geographic Career Progression, PCS Orders, and the Rules of Detailing
  21. Operational Assignments & Deployments
  22. A Rank Appropriate Guide to “Alternative” Billets & Career Paths
  23. The Career Intermission Program
  24. Executive Medicine
  25. Change in the Military Health System
  26. Retirement and Resignation
  27. Transitioning to the Naval Reserves
  28. Transition to Civilian Employment
  29. Specialty Specific Information
    1. Aerospace Medicine
    2. Allergy/Immunology
    3. Anesthesiology
    4. Cardiology
    5. Cardiothoracic Surgery
    6. Dermatology
    7. Developmental Pediatrics
    8. Diagnostic Radiology
    9. Emergency Medicine
    10. Endocrinology
    11. Family Medicine
    12. Fleet Marine Force
    13. Fleet Medicine
    14. Flight Surgery
    15. Gastroenterology
    16. General Surgery
    17. Global Health
    18. Hematology/Oncology
    19. Infectious Disease
    20. Internal Medicine
    21. Neonatology
    22. Nephrology
    23. Neurology
    24. Neurosurgery
    25. Obstetrics/Gynecology
    26. Occupational Medicine
    27. Ophthalmology
    28. Orthopedics
    29. Otolaryngology
    30. Pain Medicine
    31. Pathology
    32. Pediatrics
    33. Physical Medicine & Rehabilitation
    34. Plastic Surgery
    35. Preventive Medicine
    36. Psychiatry
    37. Pulmonary/Critical Care
    38. Radiation Oncology
    39. Rheumatology
    40. Sports Medicine
    41. Undersea Medicine
    42. Urology