Tips to Get Selected for GME

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The Graduate Medical Education Selection Board (GMESB) results were released last month with a 30 DEC deadline to accept or decline any spots you were offered.  Undoubtedly there were some people who didn’t get what they want. I’ve participated in the last three GMESBs and would like to offer tips for people looking to match for GME in the future.  We’ll cover general tips and those specific for internship and residency/fellowship:

General Tips

  • Money is getting tight for permanent change of station (PCS) moves at BUPERS.  I think you can increase your chances of matching in GME by being local, or at least on the same coast, as the GME program where you want to train.  Keep this in mind when you are picking your Flight Surgery (FS), Undersea Medical Officer (UMO), General Medical Officer (GMO), or post-residency assignments.
  • You can increase your score at the GMESB by having publications.  If you want to give yourself the best chance of maximizing your score, you need at least two peer-reviewed publications.  Any publications or scholarly activity have the chance to get you points, but having two peer-reviewed publications is the goal you should be trying to reach.
  • Be realistic about your chances of matching.  If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty.  There are some specialties where you can overcome a major blight on your record, but there are some where you can’t.  If this is applicable to you, the residency director or specialty leader should be able to give you some idea of your chances.  Will they be honest and direct with you?  I’m not sure, but it can’t hurt to ask.
  • If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian.  By the time you pay back your commitment to the Navy, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student.  You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles.

Tips for Medical Students Applying for Internship

  • Do everything you can to do a rotation with the GME program you want to match at.  You want them to know who you are.
  • When you are applying for internship, make sure your 2nd choice is not a popular internship (Emergency Medicine, Orthopedics, etc.).  If you don’t match in your 1st choice and your 2nd choice is a popular internship, then it will likely have filled during the initial match.  This means you get put in the “intern scramble” and you’ll likely wind up in an internship you didn’t even list on your application.
  • Your backup plan if you don’t match should be an alternative program at the same site where you eventually want to match for residency.  For example, in my specialty (Emergency Medicine or EM) we only have residencies at NMCP and NMCSD.  If someone doesn’t match for an EM internship at NMCP or NMCSD, they will have a better chance of eventually matching for EM residency if they do an internship locally, like a transitional internship.  Internships at Walter Reed or any other hospital without an EM program are quality programs, but it is much easier to pledge the fraternity if you are physically present and can get to know people, attending conferences and journal clubs when you can.
  • You need to think about what you will do in your worst-case scenario, a 1-year civilian deferment for internship. Many of the medical students I interviewed did not have a plan if they got a 1-year deferment.  I think every medical student needs to do one of two things.  Either they should pick 10-15 civilian transitional year internships (or whatever internship they want) and apply to those just in case they get a 1-year deferment, or they should just plan to apply to internships late or scramble if this unlikely event happens to you.  Most medical students do not grasp the concept that this could happen to them and have no plan to deal with it if it does.  It is an unlikely event, especially if you are a strong applicant, and you can always just scramble at the last minute, but this is an issue that every medical student should think through.  If you are going to just scramble at the last minute, that is fine, but it should be an informed choice.

Tips for Officers Applying for Residency or Fellowship

  • You should show up whenever you can for conferences and journal clubs.  Again, you want them to know who you are and by attending these events when you can you demonstrate your commitment to the specialty and their program.
  • Always get a warfare device (if one is available) during your FS, UMO, or GMO tour.  Not having it is a red flag.

Another Good NDAA Article – Avalanche of Enacted TRICARE Changes Poses Challenges

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Here is another good article about the NDAA and its impact on the military health system by Tom Philpott:

(Click Here for a Weblink to the Article)

The National Defense Authorization Act (P.L. 114-328), signed into law Dec. 23, orders an avalanche of changes to the TRICARE health care benefit used by servicemembers, retirees, and their families. It also makes sweeping reforms to how the military direct-care system is organized and operates.

The sheer number of changes and additional studies being mandated, filling 40 sections and 150 pages of the act, is more impressive than any short list of highlights we might be able to review here.

“There’s a lot of good stuff in there. There’s a lot of stuff we’re still puzzling over,” said Dr. Karen S. Guice, acting assistant secretary of defense for health affairs. She will serve in that post only two more weeks, until the Trump administration assumes responsibility for the $50-billion-a-year military health care system and a beneficiary population of 9.6 million.

The authorization act for fiscal 2017 “is full of ideas, concepts, and new things for us to tackle,” said Guice in phone interview. She added that it contains “a remarkable series of provisions that set forth some challenges [and] provides us with new authorities that we’re greatly looking forward to.”

But Guice emphasized many new provisions to modernize TRICARE and improve access will only accelerate reforms that the department already has been piloting or planning to adopt, though perhaps not at the speed Congress desired. The department’s guide has been recommendations of the 2014 Military Healthcare System Review, which then-Defense Secretary Chuck Hagel ordered to take a hard look at performance and outcomes at military facilities and through civilian purchased care networks, Guice said.

Beneficiaries have started to see the fruits of that effort in greater access to care and a nurse advice line. They will see more when the new generation of TRICARE purchased care contracts takes effect this year, and also with gradual rollout of MHS Genesis, the new electronic health records system. All this before many of the new defense bill initiatives kick in in 2018 and years beyond. Associations advocating for beneficiaries wonder how many changes the health system can implement before chaos rules.

Guice doesn’t sound worried for the staff she’s leaving behind.

“We have a lot of very experienced, motivated people who just like to tackle challenges,” she said. “Also, we are looking at this across the enterprise, so it’s the Army, Navy, Air Force all coming together about how we actually do this.”

The Senate version of the defense bill had called for dismantling the medical headquarters of the Army, Navy, and Air Force surgeons general. The enacted law is a compromise that directs a shift of key management functions done by the services to the Defense Health Agency, leaving the surgeons general to recruit, educate, and train their military and civilian health care providers and to advise DHA on medical readiness issues.

“That’s an interesting construct,” said Guice. “And we’re kind of figuring out how best to optimize what Congress is intending to achieve.”

Congress staggered deadlines in the law across a span of years.

“They knew there was a lot of work here and allowed flexibility by pushing out some timelines or saying do this work and then the timeline kicks in,” Guice said. “I think they want us to take our time and get it right.”

There are gems in the law for families seeking more timely care.

One provision ends a requirement that TRICARE Prime users get referrals from primary care providers before using a neighborhood urgent care facility. Another provision mandates that military treatment facilities with urgent care clinics keep them open daily until at least 11 p.m.

Those “are both wins for families,” said Brooke Goldberg, deputy director of government relations for family issues at Military Officers Association of America. Other law highlights she noted require:

  • Adoption of a standardized appointment scheduling system across all of military health care and also first-call resolution of appointments.
  • New TRICARE contracts incentives to improve beneficiary access, care outcomes, and enhanced beneficiary experiences.
  • Adoption of new productivity standards for care providers in military treatment facilities, which should mean more on-base appointments.
  • Military providers’ performance reports to include measures of accountability for patient access, quality of care, outcomes, and safety.

Military families will be eligible by 2018 to buy vision coverage through federal employee health programs, explained Karen Ruediseuli, government relations deputy director for National Military Family Association. Retirees and dependents will be eligible for both dental and vision programs.

Some changes touted by Congress are not quite what they seem. For example, the planned narrowing of three insurance options – TRICARE Prime, Standard, and Extra – down to two, with Prime still providing managed care and TRICARE “Select” offering a preferred provider network, is largely a name change push by DoD. Goldberg said it could even be “transparent to families who really don’t know the nuances of Standard vs. Extra.”

Many beneficiaries, she added, “just know they have to pay more if they see one [civilian] provider over another. Many have been using Extra, calling it Standard, and not realizing it.”

Still to be determined “is what the preferred-provider network will look like and will families be able to easily discern which services will result in higher costs? And will they have access to providers who are low-cost?”

For example, current TRICARE provider networks include those who participate in Prime and agree to take a discount from the normal Medicare-based payment. But many providers willing to see Standard patients for its allowable fee will not see Prime patients with its lower fee.

“Will those providers be considered preferred providers under TRICARE Select, or will the Select network only include those who participate as part of the Prime network? If the former is true, then the transition likely will be smooth. If the latter is true, many more people could be hit with out-of-network charges, to the extent they aren’t grandfathered,” said Goldberg.

Adding some confusion is language that grandfathers current generations of military families and retirees from a new schedule of higher fees to hit those who enter service on or after Jan. 1, 2018. But the law will require current beneficiaries to enroll in Select, as they do with Prime, and enrollment will carry a fee for retirees under age 65, beginning in 2020, if a government audit confirms improvements in quality care and patient access.

Guice took exception to one senator’s characterization of the new law as a “first step in the evolution” of military health care from “an under-performing, disjointed health system into a high-performing, integrated” one.

She noted a recent National Academy of Medicine study on military trauma care that found that over a decade of war the U.S. military had made unprecedented gains in survivability rates from battlefield wounds.

“I don’t think that’s reflective of an underperforming system at all,” Guice said. “The people who created that learning system of care are the same people who provide the in-garrison care. That is evidence we really do value constant performance improvement.”

To comment, write Military Update, P.O. Box 231111, Centreville, VA, 20120 or email milupdate@aol.com or twitter: @Military_Update

Director of Mental Health Position at NMCP – O5/O6

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The Director for Mental Health (DMH) has oversight of a full range of clinical services through two Departments: Mental Health (inpatient and outpatient), and the Substance Abuse Rehabilitation Program (SARP).  The DMH ensures the delivery of high quality and safe mental health care at 11 separate geographic locations that include the Medical Center, 7 branch medical clinics and 3 SARP locations.  Specialty services include Warrior Recovery PTSD and TBI programs, Intensive Outpatient and Crisis Stabilization programs, Child and Family Services, Tele-Behavioral Health Services, Fleet Embedded Mental Health, and Continuing Psychiatric Care for severely mentally ill active duty members receiving a medical board.  The SARP program offers all levels of treatment, and is dual diagnosis capable with 72 beds for residential care.  The 2 Inpatient Psychiatric Wards have a combined 32 inpatient beds and average 136 admissions per month.

The DMH provides operational and strategic oversight for the behavioral health of service members and their families in the Tidewater area and works in close association with medical leaders in the Tidewater Military Health System that includes Fort Eustis, and Langley AFB.  In addition, the DMH continually works to improve the support the Directorate for Mental Health provides to shore and operational commands through assessment, fitness for duty evaluations, treatment, consultation, and education.  Finally, the DMH collaborates with two Program Directors, managing three nationally accredited doctoral-level training programs: a psychiatric residency program, a psychology internship, and a psychology post-doctoral fellowship, and ensures the availability of well-qualified faculty and highly relevant training rotations.

The Directorate staff consists of approximately 360 personnel (active duty, General Schedule, and contractor).  The Director is a full voting member of the Command Executive Board, and participates in the governance of hospital operations. While the DMH position requires full-time participation, it is expected that the Director will be involved on a limited/part-time basis in patient care, typically as a Licensed Independent Practitioner.  The position is open to Navy Medical Department officers of all Corps at the O-5/O-6 level whose professional education and training would place them within the Directorate of Mental Health.  The individual selected will be expected to formally assume the responsibilities of DMH in the summer of 2017. Individuals not already resident in the Tidewater area will need to be available for Permanent Change of Station orders in anticipation of a 3-year assignment.

The preferred candidate must meet the following standards:

  • A track record of broad superior performance in both clinical and leadership positions;
  • Effective interpersonal communication, and collaboration skills;
  • Proven ability to function in operational and academic settings and to guide staff in meeting clinical competency and program accreditation standards;
  • Superior military bearing.

Interested candidates should submit (preferably via e-mail) a letter of intent, CV, BIO, PRIMS Data and Letters of Recommendation (no more than three total)  no later than COB February 03, 2017 to:

CAPT Shannon Johnson, MSC, USN

Director, Mental Health

Naval Medical Center Portsmouth

620 John Paul Jones Circle

Portsmouth, VA 23708

(e-mail address is in the global address book)

Official 2017 Military Pay Chart

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Here is the official (meaning I got it from DFAS) military pay chart for 2017:

2017 Military Pay Chart

Military Officers Association of America Article – President Signs NDAA

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There are many changes coming our way from the 2017 National Defense Authorization Act.  Here is a brief article that summarizes some of the changes:

President Signs NDAA

The 2017 National Defense Authorization Act puts into law new requirements spanning many of DoD’s programs. Most notably, it will entail sweeping changes for the military health care system.

This newly signed legislation puts into law a number of MOAA’s priorities. Specifically, it:

  • Secures a 2.1 percent military pay raise vs. the 1.6 percent pay raise proposed by the administration. The 2.1 percent pay raise matches the average American’s, as measured by the Bureau of Labor Statistics’ Employment Cost Index.
  • Stops the force drawdown and actually increases manpower levels, especially for the Army, Air Force and Marine Corps.
  • Requires an array of reforms to improve beneficiaries’ access to timely and high-quality health care.
  • Protects currently serving and retired beneficiaries from a variety of steep TRICARE fee increases proposed in the administration’s budget.
  • Rejects a Senate proposal to cut housing allowances by $10,000 to $30,000 a year for dual-military couples and other servicemembers who share housing.
  • Provides needed survivor benefit improvements: (a) extending the Special Survivor Indemnity Allowance (SSIA) until May 2018 at $310 per month, and (b) increasing Survivor Benefit Plan (SBP) annuities for survivors of reservists who die during Inactive Duty Training, to match benefits provided for active duty deaths.

The long list of health care improvement requirements are aimed at addressing the systemic and chronic problems MOAA and others have highlighted with beneficiary access (appointments and referrals), quality of care, and safety and consistency of care.

They include changes in contracting, appointment and referral processes, and holding medical providers and commanders more accountable for productivity and consistency of beneficiary-centric care, especially in military facilities.

One major change affecting TRICARE Standard beneficiaries is that program will change, effective Jan. 1, 2018, to a preferred provider organization called TRICARE Select. Another big difference is all non-Medicare-eligible retired beneficiaries will be required to formally enroll every year in either TRICARE Prime or TRICARE Select, starting in 2018. Previously, only TRICARE Prime required a formal enrollment.

The Prime option, though largely unchanged, will be modernized such that the majority of referrals to specialists from primary care managers will no longer be required to go through a cumbersome pre-authorization process. Pre-authorizations for urgent care will also no longer be required.

All in all, MOAA believes the healthcare reforms required in the new law are very positives steps toward our goal of improving beneficiaries’ access to quality health care and elimination of administrative hassles beneficiaries have experienced too often.

2016 on MCCareer.org – A Review

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Thanks to all of you who have made 2016 a successful year for MCCareer.org.  Here is a recap of 2016:

  • Total Website Views – 43,673 (up from 10,870 in 2015)
  • Total Visitors – 18,373 (up from 3,705 in 2015)
  • Posts Published – 133 (up from 69 in 2015)
  • Joel Schofer’s Promo Prep – 2,100 views
  • Total Income – Negative $99 (the cost of the site for the year)
  • Total Hours Spent On It – Hundreds!

Here are the top 5 posts that weren’t the announcement of a promotion list (which are always very popular):

Thanks for your support!

“Full” 2.1% Pay Raise in 2017

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Here’s an article from Military Times about our pay raise and a PDF of the new pay table:

New in 2017: Expect rigorous debate over military pay and benefits
By: Leo Shane III, Military Times, December 27, 2016

For the first time since 2013, military personnel in January will see a “full” pay raise equal to the expected increase in private sector wages. But it remains unclear whether this is a sign of better benefits and compensation in years to come.

How Congress and the new president treat military pay and benefits will be an issue worth service members’ attention in the year ahead, since the moves will directly affect their families’ finances.

President-elect Donald Trump has already promised to boost military spending, including more personnel and equipment. He has also promised that the country will “take care of the military” better than under President Barack Obama.

Outside advocates hope this means protecting military compensation.

In recent years, Pentagon leaders trimmed expected increases for housing stipends and basic pay to instead redirect hundreds of millions of dollars to modernization and training efforts. Military officials have said it’s a distasteful but necessary tradeoff, given shortfalls in the defense budget.

But troops’ advocates and some lawmakers have said it needlessly burdens troops and their families. They successfully fought a lower pay raise proposal for 2017, and pushed back against plans for a complete overhaul of housing stipends which could have taken away thousands of dollars annually from some troops.

With the new administration they’ll push Trump’s Pentagon to hold personnel costs separate from major weapons purchases, and hope to recoup some of the lost trims in the years to come.