Guest Post – Mindset for the GMO, UMO, and Flight Surgeon

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By Dr. Keith Roxo, LCDR, MC(FS), USN*

I teach the medical logistics lecture for the flight surgery course at NAMI. I don’t do it because I love logistics or am some kind of logistical guru; I do it because it is a great way to have a discussion about mindset for young physicians.

I begin the lecture by asking if there are any medical students in the class. It seems silly, right? They smile and look around thinking that I am being silly. Next I ask how many interns or residents are in the class. I raise my own hand because I am a resident in the Aerospace Medicine program, but generally I’m the only one with my hand up. They are starting to get a little confused by my line of questioning. It is all set up for my next question: “if you aren’t a medical student, intern, or resident then what are you?”

The answer is that they are an attending physician. And after telling them that they are all, indeed, attending physicians, I get a lot of wide eyes in the crowd. The occasional student, who happens to already be board certified before going into flight surgery, already understands this, but they are few and far between.

For the last five years most of the flight surgery students have had near constant supervision and have not had the final say on any patient. Every plan or prescription had to be run through someone else before being executed. They have very little experience doing it on their own, but many are about to be thrust into that position. They need to start thinking about how they want to run their practice, solidifying resources and contacts, how do they get help for more challenging cases, how to handle a mishap, and how to transfer a patient from an austere location. Better to start thinking about this stuff from the safety of the Pensacola beaches or classroom rather than when a problem first develops.

Meanwhile, the logistics part of the talk is a way for me to get them to also think of themselves as a mini-department head. It doesn’t matter if your Marine Air Group (MAG) surgeon or the military treatment facility is supposed to manage your supplies, if you go on det or deployment missing items, it hurts you and your people. Better to be involved in your supply than to trust the system blindly.

Not all GMO positions are equal. Some are on a staff with other senior physicians. However, some are running solo with a squadron, infantry unit, etc. without much support from more experienced physicians. Getting your mindset right before you are in those positions can go a long way to better preparedness.

*The views expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.

Joint Medical Executive Skills Website for Executive Medicine AQD is Down

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I’ve received a few questions in the last 1-2 weeks about how to get the 67A Executive Medicine Additional Qualification Designator. After tracking down the latest info, it appears that for now the website is down. They are working on revamping the criteria to achieve the AQD and working the issue, but for now there is no way to get the AQD.

Once I have further info I’ll post it.

Guest Post – Why Most of You Should Switch to the Blended Retirement System

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By Dr. Keith Roxo, LCDR, MC(FS), USN*

My graduating class from the Naval Academy has just reached 20 years and the first in zone selection board for O-6 recently occurred. I was not in zone. This is because I am an O-4…for the second time. Even though I never had any intention of leaving active duty after my aviation contract, I did that very thing. Life has a way of intervening in our plans and we have to live and work within that reality. My reality was that at 10.5 years my spouse wanted me out. In hopes of averting marital disaster, I acquiesced and left active duty.

When I first arrived at the Naval Academy in 1994, the military didn’t even have the Thrift Savings Plan (TSP). The first enrollment period began in October 2001, 3.5 years after I was commissioned and more than 2/3rds of the way through my initial service obligation. Despite that, I was hooked for a bit longer as I was serving a concurrent obligation for an aviation contract that was eight years after my winging. I signed up for the TSP and have been contributing ever since. I was about to enter my first squadron and I was in the profession I had always wanted. I had no plans on leaving the military. If the Blended Retirement System (BRS) was available then I would not have switched and I would have been wrong given that I did leave active duty with no plan to return. As it turns out, my marriage failed anyway and I rejoined the military as a second time Ensign at USUHS.

By the time most physicians are able to leave, they are around half way to a retirement, as I was. I frequently tell people they shouldn’t leave the military for the money. You are giving up the ability to transfer the Post 9/11 GI Bill, the pension and the health benefit. Those are very valuable. But you shouldn’t stay for the money either. There is a lot that can happen between initially signing up for USUHS, HPSP, HSCP or FAP and when your commitment is up. Half way to a pension means you still have half to go. No amount of money is worth it if you are completely miserable and can do well enough in the civilian sector.

There have been countless articles that discuss the BRS (Editor – all of which can be seen here and here) and who, among the eligible, should or should not switch over to the new system. There are also numerous calculators that can show you, as best as possible, the actual number breakdown. However, few of these articles and calculators can account for the realities associated with leaving the military or staying until retirement eligibility. You never know what the next few years hold for you and how your goals in life may change, just as mine did.

This is why I recommend to all eligible people, who aren’t committed to well past 10 years, to make the switch to the BRS.

*The views expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.

Construct for Implementation of Section 702 of NDAA 17 (Translation – Who’s Running the MTFs Under DHA?)

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The document that tells us who is going to run military treatment facilities (MTFs) under the Defense Health Agency (DHA) was just released:

Construct for Implementation of Section 702

This quote from the first page gives you the bottom line:

As a general rule, at each MTF there will be a single military officer who will be dual­ hatted as the MTF Director, under the authority, direction, and control of the Director, Defense Health Agency (DHA), and the Service Commander, under the authority, direction, and control of the Military Department concerned. Acting on behalf of the Director, DHA, the MTF Director will determine the capacity of each MTF required to support both operational readiness and quality, access, and continuity in the delivery of clinical/health care services to members of the Armed Forces and other authorized beneficiaries.

With the objective of ensuring a “ready medical force” and a “medically ready force”, MTFs will be the default choice for the assignment, allocation, detail, or other utilization of military medical personnel. Such default will be subject to the capacity of the MTF to afford military medical personnel opportunities to obtain and maintain currency in the clinical Knowledge, Skills, and Abilities associated with their medical specialties and communities, at or above minimum established thresholds.

The drive for operational readiness and support of war fighting and operational missions take primacy over the delivery of clinical/health care services and the execution of business operations in an MTF. To this end, each Military Department will have unrestricted access to its military medical personnel for all validated war fighting and operational requirements.

 

Director for Clinical Support Services, Ft. Belvoir – 05/06

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All of the info about this leadership opportunity are found in this document:

FBCH DCS May 2018