Need Your Opinion on the Blog/Website

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The blog/website has been live for about 2 months now, and I’d love some direction on how things are going.  Do you like written posts or do you prefer audio/video?  Do you prefer pure audio or video podcasts?  Do you like shorter podcasts or are longer ones okay?  Are written comments essential or are audio/video podcasts alone sufficient?  Please send any comments you have to me with the “Contact Me” tab or by commenting on this post.  Please also take this poll:

Moonlighting in the Navy

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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:

Moonlighting

Basic Anatomy of a FITREP

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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:

Basic Anatomy of a FITREP

BUPERSINST 1610.10D – Navy Performance Evaluation System

O5/O6 Opportunities – USUHS Brigade Commander and SECDEF Corporate Fellowship

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Here are two opportunities for senior physicians.  If you are interested in one, contact your Detailer:

O6 Only – Brigade Commander Position at USUHS

O5/O6 – SECDEF Corporate Fellowship NAVADMIN*

*NOTE: The first two programs mentioned in this NAVADMIN are for line officers and  physicians are not eligible.  The last program, the SECDEF Corporate Fellowship, is the one physicians are eligible for.

FY16 CAPT Promotion Board Statistics

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People really enjoyed seeing the FY16 CDR promotion stats and I got requests for the same stats for the CAPT promotion board.  Here they are:

# OF PEOPLE # SELECTED % SELECTED
ABOVE ZONE 155 11 7.10%
IN ZONE 101 39 38.61%
BELOW ZONE 164 1 0.61%

 

# IZ #SEL IZ % SELECT IZ # AZ #SEL AZ % SELECT AZ # BZ #SEL BZ % SEL BZ
FLT SRG 0 0 N/A 9 0 0.00% 0 0 N/A
RAM 2 0 0.00% 9 0 0.00% 3 0 0.00%
ANESTH 13 2 15.38% 10 0 0.00% 13 0 0.00%
SURG 6 3 50.00% 9 0 0.00% 7 0 0.00%
NEURO SURG 0 0 N/A 2 0 0.00% 2 0 0.00%
OB GYN 4 3 75.00% 11 1 9.09% 10 0 0.00%
GMO 0 0 N/A 0 0 N/A 0 0 N/A
OPHTH 0 0 N/A 2 0 0.00% 5 0 0.00%
ORTHO 7 2 28.57% 10 0 0.00% 12 0 0.00%
OTO 3 1 33.33% 2 0 0.00% 8 0 0.00%
URO 0 0 N/A 1 0 0.00% 4 0 0.00%
PREV MED 1 0 0.00% 3 0 0.00% 2 0 0.00%
OCC MED 4 3 75.00% 4 0 0.00% 4 0 0.00%
PHYS MED 1 0 0.00% 0 0 N/A 0 0 N/A
PATH 2 1 50.00% 9 0 0.00% 5 0 0.00%
DERM 5 2 40.00% 0 0 N/A 2 0 0.00%
EMERG 8 4 50.00% 7 0 0.00% 11 0 0.00%
FAM PRAC 9 4 44.44% 28 4 14.29% 15 0 0.00%
INT MED 18 7 38.89% 10 1 10.00% 20 1 5.00%
NEURO 0 0 N/A 2 0 0.00% 0 0 N/A
UMO 4 0 0.00% 1 0 0.00% 2 0 0.00%
PEDS 4 2 50.00% 9 2 22.22% 9 0 0.00%
NUC MED 0 0 N/A 0 0 N/A 0 0 N/A
PSYCH 4 2 50.00% 2 0 0.00% 8 0 0.00%
DIAG RAD 6 3 50.00% 14 3 21.43% 21 0 0.00%
RAD ONC 0 0 N/A 1 0 0.00% 1 0 0.00%
TOTAL 101 39 38.61% 155 11 7.10% 164 1 0.61%

FY16 CDR Promotion Board Statistics

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Here are the FY16 CDR promotion board statistics.  After a few more weeks of reviewing records of those who failed to select, I’ll have some specific promotion board takeaways.

 

# OF PEOPLE # SELECTED % SELECTED
ABOVE ZONE 113 24 21.24%
IN ZONE 135 71 52.59%
BELOW ZONE 370 0 0.00%

 

1Z FAILED TO SELECT IZ SELECTS AZ SELECTS IN ZONE % SELECTED IN ZONE TOTAL IZ & AZ SELECTS IZ & AZ PERCENT SELECTED IZ & AZ
FLT SRG 1 1 1 2 50% 9 2 22%
RAM 0 2 0 2 100% 10 2 20%
ANESTH 4 9 4 13 69% 23 13 57%
SURG 5 3 4 8 38% 19 7 37%
NEURO SURG 0 0 1 0 N/A 1 1 100%
OBGYN 1 7 1 8 88% 11 8 73%
GMO 0 0 0 0 N/A 0 0 N/A
OPHTH 1 2 0 3 67% 3 2 67%
ORTHO 3 4 1 7 57% 13 5 38%
OTO 1 0 0 1 0% 3 0 0%
UROLOGY 1 1 0 2 50% 4 1 25%
PREV MED 3 4 1 7 57% 11 5 45%
OCC MED 3 2 1 5 40% 10 3 30%
PHY MED 1 0 0 1 0% 1 0 0%
PATH 4 0 1 4 0% 8 1 13%
DERM 1 1 1 2 50% 5 2 40%
EMERG 8 3 3 11 27% 19 6 32%
FAM MED 4 10 2 14 71% 30 12 40%
INT MED 7 6 1 13 46% 17 7 41%
NEURO 3 1 0 4 25% 5 1 20%
UMO 1 0 0 1 0% 1 0 0%
PEDS 4 4 1 8 50% 14 5 36%
NUC MED 0 0 0 0 N/A 0 0 N/A
PSYCH 1 4 0 5 80% 11 4 36%
RAD 6 7 1 13 54% 19 8 42%
RAD ONC 1 0 0 1 0% 1 0 0%

 

Click on this to make it larger, if needed:

Specialty Graphs

 

2015 Graduate Medical Education BUMED Note Released

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Here is the 2015 Graduate Medical Education BUMED Note:

BUMEDNOTE 1524 – GME

O5 Promotion List Released

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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.

FY-16 ACTIVE-DUTY NAVY COMMANDER STAFF CORPS SELECTIONS

Introduction to Medical Corps Special Pays

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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?

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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:

  1. 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.
  2. 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.
  3. 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.
  4. Apply for the Navy Career Intermission Program and take time off to get a degree.
  5. 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.
  6. 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.