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.
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:
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.
Here is the latest of my financial planning articles from one of our specialty society newsletters:
Here is the text as well:
The previous installment of “Dollars & Sense” reviewed the principles of investing for retirement, and this article discusses an easy way for physicians to plan for retirement. It isn’t necessarily the best way and certainly isn’t the only way, but it is a plan that will likely lead to a very successful and potentially even early retirement.
Step 1 – Calculate How Much You Need to Save for Retirement
Total up your household’s gross (pre-tax) income for the year. Include all sources of income, literally all the money you make from anywhere. Multiply that number by 20%. That is how much you need to save annually for retirement. While the traditional recommendation is that you save 10-15% of your income for retirement, saving 20% (or more if you can) will ensure you save enough and have the option of an earlier retirement or the freedom to cut back on your workload at some point.
As an example, let’s pretend your household makes $300,000 annually before taxes. Multiple that by 20% and you’ll see that you need to save $60,000/year for retirement.
Step 2 – First Fill All Your Tax-Advantaged Retirement Accounts
You likely have many different retirement accounts available, so here is the order in which you should invest. Start with the first action and move down the list.
1. Contribute to any employer-provided retirement account up to the maximum that your employer will match. This is free money you can’t afford to leave on the table.
2. Maximally fund any tax-deferred retirement accounts you have, like your 401k or 403b. If you are self-employed you may have other options like a SEP-IRA or individual 401k.
3. Fund an IRA for both you and your spouse/partner, if applicable. If your income renders you ineligible to contribute to a Roth IRA but you still wish to do so, use the “backdoor” Roth IRA approach.(https://personal.vanguard.com/us/insights/video/2505-Exc2)
4. Put any remaining retirement funds into a taxable mutual fund.
You may have other options, such as funding a Health Savings Account as a “stealth IRA.” Some believe in using life insurance as an investment, but I don’t recommend that. In general, after you’ve maxed out the contributions to all of your tax-advantaged accounts, you’ll have to put the rest in a regular, taxable investment account.
For some of the options above you’ll have to decide whether to pursue a Roth option (pay taxes now) or use the traditional tax-deferred approach (pay taxes when you withdraw the money in retirement). That decision will depend on your individual financial situation, current and anticipated future tax brackets, and what options your employer offers. There are many on-line calculators to help you decide this.
Using our $60,000 example from above, you would contribute $18,000 to your 403b, and then fund $5500 toward an IRA for both you and your spouse, leaving $31,000 to put into a taxable investment account. If your employer contributes to your retirement, you could also count that amount toward your $60,000 total contribution.
Step 3 – Invest Your Retirement Savings in Low Cost, No Load, Index Mutual Funds
You will have to take a look at the investments offered by your various plans and select from that menu. The principles that should guide you:
1. Favor index funds over actively managed funds. You’re investing for the long term, and over that time frame almost no actively managed funds will beat index funds. In addition, because past performance does not predict future performance, there is no way to predict which funds will beat their indexes.
2. Favor mutual funds with low expense ratios that do not charge a load. The expense ratio should be less than 1.0, preferably less than 0.5, and optimally less than 0.25. If you want to keep this really easy, just invest in Vanguard index funds as all of them meet these criteria.
3. Realize that in order to beat inflation over the long haul, you’ll likely need to invest some of your portfolio in stock index funds. What percentage you invest in stocks will depend on your time horizon, risk tolerance, and individual situation. A number of guidelines from trusted references are below:
- Malkiel & Ellis suggest this as a conservative asset allocation:
|AGE GROUP||PERCENT IN STOCKS||PERCENT IN BONDS|
- They suggest this as a more aggressive asset allocation, which is my personal favorite due to the security offered by my inflation-adjusted military pension:
|AGE GROUP||PERCENT IN STOCKS||PERCENT IN BONDS|
- John Bogle suggests, as a conservative asset allocation rule, that your percentage of assets in bonds should equal your age. In other words, at age 30 you should have 70% in stocks and 30% in bonds. A more aggressive version is to subtract 10 from your age, so at age 30 you’d have 80% in stocks and 20% in bonds.
One very easy way to let someone else make this decision for you is to pick a target date retirement fund as your investment vehicle. Many investment companies offer these. You just pick the approximate year you plan to retire – that year will likely be in the name of the fund (Target Retirement 2035, for example) – and invest in that fund. Your investments will gradually get more conservative as you age without any action on your part. Just make sure that the target date funds you have access to are composed of index funds with low expense ratios. Again, using Vanguard funds makes this a no-brainer. A target date retirement fund composed of actively managed funds with expense ratios greater than 1.0 is a target retirement fund to avoid.
To close out our running example, for your 403b you invest in the target retirement 2040 fund offered by your employer’s investment firm. For both of your IRAs and your taxable account you apply the KISS (keep it simple stupid) principle, open all of them with Vanguard, and select their Target Retirement 2040 funds for all three accounts.
A simple approach like this should set you up well for retirement, and is easy enough that you can use the time you would have spent trying to manage your finances to play a little golf every now and then.
Bogle, John C. The Little Book of Common Sense Investing: The Only Way to Guarantee Your Fair Share of Stock Market Returns. Hoboken: John Wiley & Sons, Inc., 2007.
Malkiel, Burton and Charles Ellis. The Elements of Investing: Easy Lessons for Every Investor. Hoboken: John Wiley & Sons, Inc., 2013.
As this blog/website grows in popularity (4,100 hits in just over 2 months), I think readers could really benefit from other opinions than my own. With that in mind, I’d like to invite anyone interested to consider guest posting. The topic could be anything related to Medical Corps career planning. If you are interested in guest posting, use the “Contact Me” tab to pitch your idea to me. If the idea sounds promising and you’re open to a little editorial input after you submit a draft, we can get your thoughts posted to the site for others to benefit from.
Here is the FY16 Navy Medicine Professional Development Center course calendar. The most popular course for physicians on this list is the Advanced Medical Department Officer Course (AMDOC), which is great not only because it is a service school and therefore buffs your Officer Summary Record (OSR) for promotion boards, but because it teaches you a ton of useful information. (Disclaimer: I’m teaching at AMDOC this Tuesday.) The Tricare Financial Management Executive Program is another worthwhile course for senior-ish officers. It is a 3 day peek into the world of how Navy Medicine and Tricare are financed and I learned a lot of things when I attended it.
The POC for any questions about these courses is found in Appendix VI of my promotion prep document, updated yesterday and found in the tab at the top of this page and here:
This NAVADMIN extended the deadline to apply for an Officer-in-Charge (OIC) position to 8/31/15:
Here is the original BUMED Note that lists the positions available and gives you all the details:
Congratulations to the following officers who were selected for promotion to LCDR:
Medical Corps Abitria Richard R 0003 Afuhleflore Chantal Na 0044 Aleid Haydar Mohali 0034 Algert Daniel B 0104 Algert Lesley Paz 0068 Anderson William Charl 0198 Armstrong Cody Chance 0015 Aukstuolis Kestutis An 0139 Aurigemma David F 0073 Aurigemma Kristen Dian 0097 Bailey Mary Mercedes 0191 Baker Neal Jordan 0150 Baquir Angelo B 0087 Bauer Matthew Paul Per 0148 Bayly Terrence D 0083 Benjaminson Jeremy Eva 0178 Bermudez Daniela Janel 0157 Bilbao Michelle Cifone 0170 Boni Benjamin Daniel 0177 Boucher Jeromy Travis 0028 Brandon Elise Cooper 0137 Brock Marie Elizabethn 0149 Brown Taylor Adam 0055 Bruce Timothy Peter 0197 Buckley Kerry L 0053 Buckley Ryan Thomas 0041 Buckley Sarah Basha 0152 Bullard Susan Ashley 0036 Burbanodelara Patrick 0138 Burgess Matthew Daniel 0037 Butler Nathan Henry 0102 Butler William Jason 0029 Buttolph Amelia Harris 0205 Bylund William E 0084 Carter Kristopher Ever 0115 Cassleman Kristi Linne 0188 Chang Allen Duanhsu 0162 Chi Benjamin B 0096 Cochran Grant K 0063 Cole Geoffrey John 0057 Corrado Richele Lynn 0027 Cripe Paul 0079 Cruz Chris Albert 0146 Darling Nicholas Andre 0200 Davis Christopher Alan 0108 Dean Daniel Joseph Jr 0174 Deboer Derek Lee 0082 Degeus John Benjamin 0094 Delacruz Andrea Faye 0156 Derevianko Victoria Ma 0105 Digeorge Nicholas Will 0169 Douglas Brigham Lee 0193 Elek Steven IV 0172 Engkulawy Jennifer Kar 0163 Evans John Keith II 0180 Faught Sara Kathryn 0144 Fiaseu Kaycee Rose 0204 Filipescu Radu 0020 Flowers Lynn Morrissey 0155 Fofi Stephanie Marie 0145 Frasier Samuel Dennis 0208 Gage Michele M 0086 Ganacias Karen Gayle 0192 Garciasalas Alejandro 0093 Gaylord Bethany Kay 0117 Generoso Judith Cather 0130 Gillespie John W 0075 Gilman Luke Anthony 0132 Gower Jonathan Robert 0066 Graham Jennifer Nicole 0107 Greene Tatiana Morales 0186 Gutweiler Alex August 0025 Haight Sean Patrick 0175 Hall Kent Michael 0190 Hamersley Erin Rae Spa 0206 Hastings Todd Glen 0154 Hauck Heather Noelle 0095 Hauff Niels M 0050 Healy Mae Wu 0129 Hemerly Nathan James 0173 Henebry Andrew D 0046 Henry Sadie Mar 0004 Hodell Evan Mel 0014 Hoffman Marshall Mathe 0062 Hogan Patricia Elisabe 0142 Holleman Kevin Troy 0168 Holzhouser Jamon Aaron 0016 Jain Ankush Kumar 0171 Jardonaites Michelle D 0090 Jaskiewicz Jennifer Ly 0185 Jing Ling 0006 Johns Michael Wayne 0045 Karris Bianca Cabrera 0133 Khoo Di 0052 Kilimentmihaileanu Iul 0021 Kuckel Daniel P 0035 Kunkel Scott Alan 0196 Lafferty Casey Elizabe 0176 Lagrew Joseph Edward II 0099 Larsen Eric Christian 0012 Lawson Scott Michael 0122 Le Joseph An 0141 Le Tuvien 0195 Lee Blair C 0120 Lehmann Benjamin John 0143 Lewis William A 0030 Lipscomb Kathryn Ann 0118 Lomeli Matthew Charles 0164 Lopez Lance Anthony 0140 Lopreiato Joseph O 0128 Love Christopher Scott 0010 Mak Heather Kimberly 0136 Maliakel Paul G 0064 Mancusiungaro Andrew E 0043 Manosalva Rodolfo Enri 0158 Marquardt Joseph Phili 0165 Marshall Michael Thoma 0060 Maruszak Mary Brigid 0187 Mathew Manoj 0026 Mathurin Jean Gilnord 0024 Mattingly John C 0072 McClure Robert Ian 0007 McCullough Jeremy Davi 0189 McDonnell John Carroll 0167 McPeak Lesley Armbrust 0061 Melzer Jonathan M 0089 Meunier Nicole Jean 0069 Michel Eric Brian 0121 Michel Shannon Scully 0127 Monson Michael James E 0166 Munoz Beau Jeffrey 0031 Myles David Eric 0201 Naff Jessica Lynn 0011 Navarro Carlos Alberto 0048 Nelson Mikal John 0042 Nieves Maria Lizette 0005 Obrien Brendan Stephen 0077 Oladipo Olamide Johnso 0135 Olson Erik Joseph 0051 Osborne Todd Graham 0013 Overbey Jamie Kathleen 0147 Owens Steffanie Michel 0100 Pannier Aaron Granvill 0092 Partovi Christopher Re 0032 Perrinez Phillip Rober 0113 Perry Alexandra V 0088 Peterson Brandon Rober 0119 Powers Michael F 0159 Prokop Michael Aaron 0184 Reynders William Josep 0116 Roberson Nolen F 0080 Roden Christopher Dona 0183 Ross Warren Leslie 0111 Russell Matthew Craig 0008 Ruttenberg Todd Michae 0101 Santiago Gabriel F 0049 Sardina Jonathan Micha 0181 Sasovetz Scott Joseph 0059 Schonau Jesse Taylor 0207 Scully Stephenie Ashle 0058 Seeger Daniel Bradley 0123 Shanahan Erik Edmond 0071 Siebenaler Joseph Fran 0179 Siegel Joseph Aaron 0039 Simmons Brett Patrick 0112 Singer Jacob Emerson 0040 Skeehan Christopher Do 0134 Smith Jennifer Lauren 0085 Snow Ryan William 0161 Solis Ana Lidia 0023 Sone Peter Lee 0056 Songer Adam G 0081 Speicher Matthew Vanst 0199 Staeheli Gregory R 0047 Stange Christopher Jam 0203 Stanila Vlad Vasile 0022 Stapleton Robert Edwar 0202 States Leith Jason 0182 Steele Helen Marie 0194 Stein Loretta Lindsay 0125 Stonegarza Kristi Kim 0009 Stratton Michael Slade 0151 Stromberg Ines Haruni 0131 Talise Paul C 0076 Taylor Jacob Marshall 0038 Toupin Brian 0103 Trevino Ruth Ann 0124 Uber Ian Chauncey 0067 Valadao Jason Matteo 0018 Wagner Kari Lynn 0110 Wagner Scott C 0106 Waite Kenneth Barry Jr 0126 Wallace James D 0078 Walsh John C 0074 Waterman Adam Thomas 0070 Westbrook James Wesley 0017 Wheelan Ann Victoria 0019 Wildi Jonathan Douglas 0160 Wilson Jessica Ann 0098 Wilson Kevin F 0114 Wolf Michael E 0054 Wooldridge Bryan Edmun 0109 Zelinskas David John 0153
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:
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:
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.
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:
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: