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Updated Physical Fitness Assessment (PFA) Rules
Here is an article that discusses the new physical fitness assessment (PFA) rules and policy that was release in a NAVADMIN this week. The changes, effective immediately, include:
- There is a new body composition assessment (BCA) procedure, which consists of a three-step process.
- The first measurement uses the current height/weight tables.
- If an individual fails to meet those standards, a single-site abdominal circumference measurement will be conducted.
- The final opportunity for Sailors to pass the BCA will be a test using the previous system of neck and waist measurements to calculate body fat percentages.
- Sailors will pass the BCA by meeting the Depart of Defense maximum allowable body fat limit of less than or equal to 26 percent for males or 36 percent for females.
- If you are medically cleared to take the physical readiness test (PRT) you must participate in the test regardless of your BCA results.
- You will face separation from the Navy if you fail two PFAs in a three-year period.
- Commanding Officers are now empowered to conduct BCA spot check programs to ensure Sailors are staying within standards. This moves the Navy beyond a two-test-a-year system by giving commands the ability to identify Sailors in need of additional support without subjecting them to administrative punishments that result from an actual BCA/PRT failure.
Additional info can be found at this 21st Century Sailor site.
Congress and Military Healthcare Reform
Recently there have been some high level discussions in the Senate Armed Services Committee, including our top Navy admirals, about reforming the Military Health System (MHS).
Here is a transcript of the congressional testimony of Dr. Jonathan Woodson, the Assistant Secretary of Defense for Health Affairs, and VADM Raquel Bono, Director, Defense Health Agency. In addition, here is an article that summarizes their testimony. The Navy Surgeon General, VADM C. Forrest Faison III, also provided testimony that can be read here. My summary of important points includes:
- The overarching strategy for the MHS is what they call the “Quadruple Aim.” This is to ensure readiness, improve health, improve healthcare, and lower cost.
- There is talk of military providers obtain admitting privileges at nearby civilian institutions. We could then provide a wider range of care for military beneficiaries and improve our clinical skills maintenance. In addition, here is an article that discusses allowing civilian trauma cases at more military hospitals.
- The MHS will provide a robust clinical experience to preserve skills and competencies by moving more workload in-house, growing our patient enrollment, rebalancing staff and investing in our graduate training programs.
- The MHS is extending hours to evenings and weekends in a number of military treatment facilities (MTFs).
- The MHS is encouraging the use of telehealth and smart phone applications.
- The Department of Defense (DoD) is implementing a pilot program that allows patients to access urgent care centers without requiring a preauthorization.
- DoD with reduce TRICARE regions from three to two, eliminating unnecessary administrative overhead for both the government and contractors.
- 2016 is the first phase of deployment of the new Electronic Health Record in the Pacific Northwest.
- The MHS will encourage beneficiaries to use MTFs by eliminating administrative burdens that impair access to care.
Navy Legislative Fellowship NAVADMIN Released
This NAVADMIN solicits applications for the 2017 Navy Legislative Fellowship Program. The Legislative Fellows Program allows naval officers, senior enlisted and Department of the Navy civilians to broaden their understanding of the legislative process and the operation of the U.S. Congress through a year-long full-time assignment to the office of a Member of the House of Representatives or the Senate. The Legislative Fellows Program also enhances the Navy’s ability to fulfill its role in the national policy development process.
2. This is a highly competitive program. Applicants records must reflect sustained superior performance and potential for future assignments in critical billets. Upon completion of the program, officers earn a Legislative Additional Qualification Designator. Additionally, there is an opportunity to earn a Legislative Studies Certificate through a sponsoring agency.
3. Military Applicants. Participation is open to unrestricted line officers, restricted line officers, and staff corps officers in the permanent grades of O-3 through O-5. Enlisted participation is open to all rates in the permanent grades of E-7 through E-9. The selection process will focus on individual performance, promotion potential, academic and subspecialty qualifications, needs of the Navy, and availability for follow-on assignment. Officers with permanent change of station orders already issued will not be considered.
a. Applicants must be available for Permanent Change of Station assignment to Washington, DC, from November 2016 through December 2017. During the fellowship, officers and senior enlisted will be assigned to the Office of Legislative Affairs (OLA) for administrative purposes. Upon execution of orders, fellows agree to serve for three years following completion or termination of the fellowship. A follow-on utilization tour in legislative affairs is preferred (making career timing an important consideration), but depends on community-specific billet requirements, needed
officer progression, and availability of legislative assignments. All officer applicants must contact their detailers for counseling on the career impact of participation in the Legislative Fellowship Program.
b. Submit applications via e-mail to the OLA point of contact no later than 29 April 2016. Program information and submission guidance are available on the Navy legislative affairs website.
c. Points of contact are LCDR Nicole Williams, Navy Fellows Program Manager, OLA, who can be reached at (703) 697-2885/DSN 227 or via e-mail at nicole.williams3(at)navy.mil; and LCDR Angelin Graham, PERS-440, who can be
reached at (901) 874-4056/DSN 882 or via e-mail at angelin.graham(at)navy.mil.
All 24 Podcasts Now Available on iTunes
When you are just learning how to create a website/blog and podcast, you learn as you go. I just figured out how to make sure that all 24 of the podcast episodes are available for download on iTunes. Previously I was only allowing the last 10 to be visible.
So…if you want to check out all the podcasts, click here:
Also, PLEASE leave a review of the podcast on iTunes. So far I have no feedback and any reviews would be helpful.
Normal Promotion Timeline and the Jobs/Achievements That Get You There
(Here are some Military Career Progression Slides from a career planning lecture I often give to accompany this post.)
The typical career progression for a Medical Corps officer if promoted on time (the first time they are in-zone) is:
- 5 years – selected for promotion to LCDR
- 6 years – promoted to LCDR
- 11 years – selected for promotion to CDR
- 12 years – promoted to CDR
- 17 years – selected for promotion to CAPT
- 18 years – promoted to CAPT
For example, I’m a 15 year CDR, so I’ll be in-zone in 2 years at year 17. If I’m selected the first time I’m in-zone, I’ll be promoted to CAPT in year 18.
There are 5 general career paths in the Navy that lead to promotion, and I firmly believe that all can lead to promotion to CAPT. They are:
- Academic
- Administrative
- Clinical
- Operational
- Research
One of my favorite things about the Navy is that you don’t have to stay within the same career path as you progress in your career. I have happily jumped around and managed to promote to LCDR and CDR on time. During my first tour at USNH Okinawa, I was largely clinical. After that I was academic but transitioned to more of an administrative role, culminating with my time as a Detailer at PERS. In my current role as Commander of a Joint Medical Group and Joint Task Force Surgeon, I’m both administrative and operational. My next tour will return me to an academic setting where I hope to score a major administrative role at the command but once again “be academic.”
As you progress down your chosen career path, one of the major determinants of whether you will promote is whether you get the jobs that will allow you to progress to the next rank. The following lists include many, but certainly not all, of the collateral duties, positions, and achievements you should strive for once you reach each rank. If you can get some of these positions and do well in them, it should allow you to break out on your FITREPs and increase the chances you will promote. Of note, in each rank appropriate list there are positions from all 5 general career paths.
LTs or LCDRs looking to promote should focus on achieving these milestones or positions:
- Getting board certified, which is pretty much a requirement to promote
- Completing a fellowship, but trying to avoid being a fellow in the years right before they are in zone so that the non-observed FITREPs you often get don’t hurt your chances at promotion
- Completing a deployment, but again trying to avoid doing it right before you are in zone due to the small competitive groups you often get on your FITREPs
- Assistant/Associate Residency Director
- Department Head (DH) is a small/medium military treatment facility (MTF)
- Assistant Professor at USUHS, which is very easy to get if you just apply. See my promo prep document for the info on how to do this.
- Publishing professional publications
- Research, preferably defense-related
- Departmental collateral duties
- Hospital committee member or chair
- Executive Committee of the Medical Staff (ECOMS) member
- Civilian leadership positions, like in your specialty society’s state chapter, for example
- Senior Medical Officer (SMO) or Medical Director in your department at a large MTF
CDRs looking to promote should focus on:
- Residency Director
- DH of your department in a large MTF
- Associate Professor at USUHS
- Director position (Director of Medical Services, Director of Clinical Support Services, etc.)
- Officer-in-Charge of a clinic
- Major committee chair
- ECOMS member, Vice-President/President-Elect, or President
- Senior operational leadership position
- Division Surgeon
- Group Surgeon
- Wing Surgeon
- Commander, Amphibious Task Force (CATF) Surgeon
- SMO on an amphibious platform
- Staff position at BUMED
- Specialty leader
- Deployment requiring an O-5 or higher
- Detailer
As a LT or LCDR, I was able to get board certified, complete a fellowship at the right time, deploy twice, become an Assistant Professor at USUHS, publish numerous publications, do some research, obtain numerous departmental collateral duties, chair a hospital committee and be an ECOMS member at USNH Okinawa, become a SMO in the Navy’s largest emergency department, be an Associate Director at a large MTF, and hold numerous civilian leadership positions.
As a CDR so far I have promoted to Associate Professor, been a major committee chair and member of ECOMS, and served a tour as a Detailer. Currently I’m a specialty leader and am deployed in a senior operational role that required a CDR or CAPT.
All of this took a lot of work, but made it easy for my leadership to fight for and justify early promote (EP) FITREPs that allowed me to promote to LCDR and CDR on time. Will it work for CAPT? We’ll have to wait on that, but the more of these things you can achieve, the easier it will be for your leadership to do the same thing for you. You need competitive EPs to promote, and doing these things, giving your leadership the ammunition to justify EP FITREPs, is the path to getting them.
MCCareer.org – 2015 in Review
Happy New Year to all MCCareer.org users. In 6 months, we got 11,000 views. If you’d like to see the statistics, top posts, top commenters, and other similar things, see below. Thanks for making this blog an impactful and valuable resource.
The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.
Here’s an excerpt:
The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 11,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 4 sold-out performances for that many people to see it.
Highlights of BUMED Specialty Leader Business Meeting
I was recently selected to be the Emergency Medicine Specialty Leader, and earlier this week I attended the BUMED Business Meeting for Specialty Leaders and Program Directors. Below are the highlights I thought were of interest to a general Medical Corps audience:
- BUPERS is removing the AZ (above zone) and IZ (in zone) stamps on the Officer Summary Records (OSR) for all promotion boards starting with the upcoming FY17 promotion boards. Some feel that when officers are labelled “AZ” that board members assume that something must be wrong with them since they failed to select previously. This is being done to reduce the chance of that bias (if it even really exists). Obviously if you have been passed over for promotion and you have a ton of FITREPs at your current rank or the board members closely scrutinize your date of rank on the OSR, they will be able to figure out pretty easily that you are AZ, but without the stamp it will make it harder for them to do so.
- There is a POSSIBILITY that they change the promotions in the future so that the top 10% of officers selected for promotion get to put the new rank on first. Currently the order your promote is based on your lineal number and seniority. In other words, the officers who have been passed over most get to put the new rank on first. They MAY switch to a system where merit determines who promotes sooner rather than seniority.
- DMHRSi is something that very few Medical Corps officers like, but you should realize that the data you put into it is clearly used by BUMED to make decisions that impact manning and measure your productivity. You should do what you can to correctly reflect your workload in DMHRSi.
- The rollout of the new electronic medical record is slated to begin in the Pacific northwest in 2016, but it MIGHT be pushed to the right into 2017. The total rollout is scheduled over a 5 year period.
- The career intermission program is being expanded. You can use it to take up to 3 years off, essentially hitting the pause button on your career. You retain 1/15th of your basic pay and your benefits, like TRICARE, and will owe a 2 for 1 time to the Navy upon your return. For example, if you take 2 years off, you’ll owe 4 years when you return to active duty. When you return, your lineal number and promotion cycle is reset so that you don’t lose any time and you jump back into a year group that you can compete with for promotion. There is info on the program here, OPNAV 1330.2B – Navy Career Intermission Program Guidelines or at this website.
- The conference approval process is arduous and painful, but it MIGHT be getting easier. For now it will remain the same and require multiple forms. If you are going to something that is a “course” and not a “conference” then your Specialty Leader can see if BUMED legal will exempt the course from the approval process. The POC in that office says that courses have been exempted successfully, and once they are exempted then all officers can use that exemption if their command is willing to pay for the course. Here is the conference approval webpage. You should always check here for the latest information.
4th Step to Financial Freedom – Contribute Maximally to Your Tax-Favored Retirement Accounts
The benefits of tax-favored retirement plans like the Thrift Savings Plan or an Individual Retirement Account (IRA) are too great to ignore, and over the span of your career sheltering your investment earnings from the taxman will benefit you tremendously. For example, assume that you make a $4,000 annual contribution for 45 years and earn an 8% annual return. Here is how much you would have if you invested in a taxable investment account versus a tax-deferred account:
- Taxable investment total – $604,407
- Tax-deferred investment total – $1,669,670
As you can see, the power of keeping your investment returns and not paying taxes on them can lead to huge differences in the amount of investment growth you will experience.
The primary tax-favored investment account that is available to us is the Thrift Savings Plan (TSP). If possible, you should always contribute the maximum amount each year, which is $18,000/year in 2015 and 2016 ($24,000/year if you are over 50). You may be able to contribute more if you are deployed in a combat zone. See this TSP Annual Limit on Elective Deferrals PDF to read about the details.
After you fill your TSP, open an IRA and, again, contribute the maximum amount each year. The contribution limits for 2015 and 2016 are $5,500/year ($6,500/year if you are over 50).
For both the TSP and IRA you’ll face the decision of whether to contribute to a Roth or traditional version. Roth contributions are taxed now, meaning you make after tax contributions and future withdrawals are tax free. Traditional contributions are taxed when you withdraw, meaning you make pre-tax contributions now and pay taxes later. For younger or military people, the Roth is usually more advantageous because your tax rate is lower than it will be in the future, but there are many on-line calculators to help you decide which option is best for you, including:
https://www.tsp.gov/PlanningTools/Calculators/contributionComparison.html
http://www.bankrate.com/calculators/retirement/roth-traditional-ira-calculator.aspx
Here is a great comparison chart from Vanguard:
https://investor.vanguard.com/ira/roth-vs-traditional-ira
The Roth IRA does require an adjusted gross income of less than $117,000/year (single) or $184,000/year (married) in 2016 to fully contribute, but there is a way around this called a “backdoor” Roth IRA. For a tutorial on how to do this, go to:
http://whitecoatinvestor.com/backdoor-roth-ira-tutorial/
If you moonlight as an independent contractor (you’ll know because you will be paid with a Form 1099), you will have other tax-favored options available to you, including a SEP-IRA or Solo 401k. In these accounts you can often contribute a lot more money. For a full discussion of them see:
http://whitecoatinvestor.com/sep-ira-vs-solo-401k/
The bottom line is that to maximize your net worth you need to maximize your contributions to all tax-favored retirement accounts you have available to you. Hiding your investment earnings from the taxman will allow you to accumulate a lot more for retirement.
3rd Step to Financial Freedom – Debt Management
“Annual income, twenty pounds; annual expenditure, nineteen pounds; result, happiness. Annual income, twenty pounds; annual expenditure, twenty-one pounds; result, misery.” – Wilkins Micawber in David Copperfield
Debt has a bad reputation. It is prevalent, no one wants it, and everyone who has it wants to get rid of it. Everyone wants to be debt free.
There is, however, another way to look at debt. Debt is a financial tool to meet your personal and financial goals. For example, according to the Association of American Medical Colleges the median level of medical student debt was $180,000 in 2014. While we’d all agree that this level of debt is high, when necessary it has allowed most of us to meet our personal goal of becoming a physician.
Dealing with Debt Wisely
Banks and financial institutions see physicians as low-risk and are willing to loan us a lot of money, which can be good or bad. You can probably get a loan to buy a $100,000 luxury car, and while this might be fun, it is probably not wise. The same thing goes for a jumbo mortgage.
Every time you are considering a loan, you should ask yourself if what you are about to purchase is worth it. Will that fancy car or extra large house truly bring you happiness? Or does it just bring a ton of overhead, increased expenses, and four extra rooms you’ll need to buy furniture for.
The book The Millionaire Next Door by Stanley and Danko was a longitudinal study of millionaires. This study showed that most millionaires don’t drive expensive cars. In fact, most drive “normal” cars or buy them used. In addition, most don’t live in large houses in expensive neighborhoods. Their study showed that physicians are notorious for buying these items to live up to society’s expectations. Doctors are supposed to drive luxury cars and live in expensive neighborhoods, right? This is also why they found that physicians under accumulate wealth and have much a lower net worth than their income would predict.
Do yourself a favor and buy a smaller house, drive a less expensive car, and avoid a boat. You don’t want to own the boat, you want to be best friends with the owner of the boat. Skip the vacation home. You can probably rent an equivalent home for much less than it would cost to buy it, and in 2013 the Nobel Prize in Economics was given to Robert J. Shiller, who showed that housing prices barely outpace inflation over the long haul, making real estate a less attractive investment.
While the ultimate goal is to get to the point where you can pay cash for cars and other major purchases, you will likely take out loans for some period of time when a major need arises. Here are some financial rules of thumb to keep you from getting in debt beyond what you can handle:
- Monthly debt payments (excluding your mortgage) should be <20% of your monthly income.
- Your housing costs should be <30% of your income.
No matter what debt you accumulate, make sure you always make your payments on time. The #1 factor that goes into calculating your credit score is your ability to make timely payments on your debt, and your credit score will determine the interest rate you are charged on nearly every loan you ever take. One late $50 payment could cost you thousands of dollars on a mortgage, for example.
Credit Cards
“Keeping a balance on your credit card is about the worst financial move you can make.” – Burton G. Malkiel, Chair of Economics, Princeton University, Author of A Random Walk Down Wall Street
The quote above says it all. If you are going to use a credit card for the convenience, always pay off the entire balance every month because the interest rates they charge can be very high. If you can’t control your credit card debt, cut them up, cancel them, or only have one that you use in special circumstances. If you have to keep credit card debt, make sure you ask your credit card company to lower the rate or transfer the debt to a low rate card. Check credit.com, cardtrak.com, or lowcards.com for a list of low rate cards.
Good Debt?
In addition to helping you achieve financial goals that are important to you, debt can be used to limit the amount of your own investments that must be in cash equivalents. Having easy access to credit can provide a nice backstop in case of a sudden need for cash.
If you have equity in your home, a home equity line of credit can serve this purpose. Their interest rates are usually low and the interest is often tax deductible, further lowering the cost of borrowing. Home equity lines of credit (and other lines of credit as well) should be set up in advance, not after you or your spouse/partner loses their job and you are a credit risk. Beware of fees your lender may charge and see if you can find one that will waive them for a slightly higher interest rate. A slightly higher interest rate isn’t that big of a deal as you hope to never use this line of credit anyway.
Student Loans
Despite the HPSP program and USUHS, many readers will have significant student loans. Since I never had student loans, I will admit that this is a weak area in my financial knowledge. By far the best source for information on student loans, paying them off, getting them forgiven, and refinancing them is The White Coat Investor. I would STRONGLY ENCOURAGE anyone, especially those with student loans, to check out this resource. It is unparalleled and the most useful financial site for physicians on the web.
Probably the most important step that residents can take to pay off their student loans is to avoid jumping straight into the “doctor lifestyle” as soon as they graduate residency. If you continue to live like a resident until your student loans are paid off, it shouldn’t take more than a few years to get rid of them, after which you can splurge a little and enjoy your income free of student loans. This is easy to type and hard to do, but just a few years of “roughing it” can wipe out your student loans.
Paying Off Debt
When you pay off debt, you are earning an after-tax return equivalent to the interest rate you are being charged. For example, if you pay off credit card debt with an 18% interest rate, this is the equivalent of earning a guaranteed 18% return on your investment tax-free. With the long-term rate of return for the stock market averaging just under 10%, you can see that paying off high-rate debt is often a better move than investing in the stock market. In other words, it makes no sense to pay the minimum on high-interest debt like credit cards while investing in the stock market. Pay off your high interest debt first.
The one exception to this is if you get an employer match on your retirement account contributions. If you get a 50% match, that is an immediate 50% return on your investment, so contribute to your retirement account up to the maximum that your employer matches, then pay off high interest debt. Unfortunately, military physicians don’t get any match right now.
If you have multiple loans, pay off the one with the highest interest rate first. In addition, see if you can stretch out the payments for your low interest loans over a longer period of time, lowering your monthly payments and freeing up cash to pay off your higher interest debts faster. For example, if you have credit card debt with a 14% interest rate, a car loan with an 8% rate, and a mortgage with a 5% rate, pay off the credit card first, then the car loan, and then the mortgage.
Keep in mind that it often doesn’t make sense to pay off debt when the interest rate is lower than the after-tax rate you could earn on an investment. If you want a number, I would pay off high-interest debt (rates greater than 6-8%) such as credit cards, car loans, and private educational loans. If the rate is less than 6%, as with most mortgages nowadays, it probably makes more sense to invest the money in mutual funds and pay off the debt as slowly as possible.
Another move to consider is to take out a home equity loan to pay off high interest debt. You get a lump sum with a fixed interest rate that is often lower than your current debt and pay it off over 5-15 years. In most cases the interest you pay is tax deductible. Keep in mind that you could lose your house if you default on this type of loan, and beware of any up front fees that you need to factor into your calculations.
Conclusion
Don’t wait until a crisis hits (divorce, job loss, disability, or a lawsuit) to get your debt in order. If you have major problems with debt and need help, seek a fee-only financial planner with experience with high-income individuals who can help you restructure and manage your debt.
Updated List of Service Schools – MedXellence and MHS Capstone Added
There are 2 new service schools, MedXellence and MHS Capstone. If you want these added to your record, check the updated promo prep document below for the procedure:
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Joel Schofer's Career Planning Blog 