MCCareer.org – The Book – Chapter 4 – Medical Corps Career Paths
By Joel Schofer, MD, MBA, CPE
(Note: The views expressed in this chapter are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.)
Introduction
There are many career paths available to Medical Corps officers. The five primary career paths include:
- Academic
- Administrative
- Clinical
- Operational
- Research
All of them can lead to promotion to O6. Here is a slide summarizing the Medical Corps career paths:
When comparing a Naval career to a civilian one, it is often easier to jump from one career path to another in the Navy than it would be in the civilian job market. All it takes is for you to take a new set of orders and you have switched career paths without having to start over. Let’s discuss the five career paths.
Academic Career Path
The academic career path involves much of the same activities as in the civilian world. You will largely be stationed at military treatment facilities (MTFs) with graduate medical education (GME) programs. In the Navy, these will include Family Medicine teaching hospitals/medical centers (Camp Lejeune, Camp Pendleton, Fort Belvoir, Jacksonville), Japanese MTFs with Japanese internships (Okinawa, Yokosuka), and medical centers with multiple residency programs and internships (Bethesda-Walter Reed, Portsmouth, San Diego). In addition, you could be stationed at the Uniformed Services University of the Health Sciences (USUHS) or in an educational support role at the Bureau of Medicine and Surgery (BUMED).
Aside from your clinical activity, you’ll be focusing on teaching and academic production. If you’re smart, you’ll work toward academic promotion in your department at USUHS by obtaining a faculty appointment (this newsletter tells you how to get one) and progressing toward academic promotion. Once you graduate from residency, you will likely be appointed an Assistant Professor, which means you are considered a local or regional expert. The next step would be to promote to Associate Professor, where you are a regional/national expert. Finally, you would strive for Professor, which usually indicates you are a national/international expert in your field.
If you receive a USUHS faculty appointment and, with the guidance of your USUHS department, actively work toward academic promotion, your academic career will be forced to progress. In my experience, most people obtain their initial appointment as an Assistant Professor but never progress from there. If you want to progress, you will need not only a curriculum vitae (CV) and biography, but also an educator’s portfolio. This portfolio can be a lot of work to create and maintain, and it is infinitely easier if you start early in your career.
The other relatively recent development in the academic career path is that there are many more options that are considered acceptable academic productivity. Traditionally, you had peer-reviewed publications and book chapters but little else. With the rise of the internet and social media, smartphone applications, blogs, podcasts, and other on-line options exist for you to produce academically and build your expertise and influence.
Research Career Path
The research career path is much like the academic one just discussed, but with a research focus. You would likely spend most of your career in MTFs with GME programs, but you can really do research anywhere in the Navy. Of particular interest, the Navy has commands whose primary missions are research, like Naval Health Research Center, Naval Medical Research Unit Dayton, and others.
Anyone planning a research career, you should strongly consider obtaining advance training. This could involve a fellowship, an advanced degree or certificate program, or additional continuing medical education. USUHS offers training in research.
Administrative Career Path
The administrative career path usually starts when you assume a leadership role appropriate for a junior to mid-grade officer. This would include Assistant Department Head, Department Head at a small/medium Military Treatment Facility (MTF), Medical Director, Senior Medical Officer, a leadership role on the Medical Executive Committee (MEC), or any other position where you assume administrative responsibility.
After the initial role, you gradually assume more responsibility, potentially at larger and at different types of commands. Although it is possible to obtain some of these roles as an O4, once you are selected to O5 a new world of positions is open to you that is easier to obtain as a CDR or CAPT. These would include Chair of a MEC committee, Department Head at a large MTF, Associate Director, Director, MEC Vice-President or President, Chief Medical Officer, Officer-in-Charge, or other positions with significant leadership roles. Once you are selected for O6, you can transition into Executive Medicine and can screen for Executive Officer and later Commanding Officer positions. If you are successful in your senior O6 leadership positions, you may be considered for promotion to the flag ranks as a Senior Healthcare Executive.
Many physicians who hope to rise to high levels of administration will try to increase their knowledge base by obtaining additional training. This can include military course like MedXellence or the Senior Officer Course in Military Justice and Civil Law. It can also include formal education in management and administration, such as a Master’s in Business Administration, Medical Management, or Healthcare Administration. There are many ways to obtain these degrees both inside and outside the service.
Clinical Career Path
The clinical career path is probably the purest and most natural career path. Why did you go to medical school? Usually, it is because you wanted to be a doctor, and the Navy needs people who want to be a doctor.
The first step in pursuing a career path is to complete a residency or fellowship in your desired field(s) of choice. After completing this graduate medical education, although not required by the Navy, you should strive to achieve board certification in these specialties, if available. First, it allows you to receive board certification pay. Second, it allows you to get a 5 in the professional expertise trait on your fitness report. Third, it is generally required to promote. Finally, when you moonlight or get out of the Navy, you will earn more than someone who is not board certified. And we all eventually get out of the Navy!
After achieving board certification, it is assumed that you will maintain it. In fact, it is required to continue receiving board certification pay. If you ever let your certification lapse, you must notify your special pays coordinator so they can terminate the board certification pay.
The downside of a purely clinical career path is that it can make it harder to promote to O6 if all you do is see patients and you are not willing to take on at least one significant collateral duty. I’m not saying it is impossible to promote as a pure clinician, but it can make it harder. On the positive side, a board certified clinician should be able to promote to O5, and some of the Commanders I know who are purely clinicians are some of the happiest physicians I know. You want me to join that committee? No thanks. I’m happy just being a doctor!
Operational Career Path
Many physicians pursue an operational career path because it is why they joined the military. You can be a doctor anywhere, but in the Navy you can be in submarines, dive, parachute, and all sorts of other fun and unique things.
An operational career path most commonly begins with a tour as a General Medical Officer (GMO) with the Marines or on a ship, a Flight Surgeon (FS), or Undersea Medical Officer (UMO). For those that go straight through in residency training, it may be that their first set of orders after residency takes them to an operational billet. In either case, physicians with an operational unit will probably find that they have a lot of responsibility for people with a work hard, play hard mentality. The 72 and 96 hour periods of leave that are common around holidays (play hard) are balanced by the requirement to deploy or train in the field (work hard).
As a physician promotes and becomes more senior, there are often opportunities to assume more senior roles specific to the operational community of choice. Along the way, it will be assumed that you are maintaining your clinical skills. Because it is often difficulty to maintain a full scope of practice in an operational setting, this may require extra effort to practice in a Military Treatment Facility or moonlight in your free time.
Summary
In summary, there are five primary career paths in the Navy. They include academic, administrative, clinical, operational, and research. In the Navy, it is usually fairly easy to transition from one career path to another without losing a step. Finally, pursuing all of them can lead to a fulfilling career and promotion to O6.
Step 2 to Crush the TSP – Decide
The Thrift Savings Plan (TSP) is the military’s retirement account. Learning how to maximize its utility should be high on your financial priority list. I’m going to create a guide that will show you how to crush it with the TSP. We already showed you step 1 in that guide. Here’s step 2…
The 2nd Step to Crush the TSP – Decide
If you want to crush it with the TSP, you’ve got some decisions you have to make. You have to decide:
- How much you’re going to invest.
- What investments you’re going to use.
Decide How Much You Are Going to Invest
If you want to crush it, you need to invest as much as you can afford. How much can you contribute? Here is the TSP page that lists the contribution limits.
That page may be confusing, so here is the bottom line:
- You can contribute $19,000 in 2019.
- If you are 50 or older, you can contribute an additional $6,000.
- If you are deployed to a combat zone, you can contribute even more.
- Any matching contributions you get from the DoD due to the Blended Retirement System or BRS (if you’re in it) does not count toward these limits.
How much should you contribute? As much as you can. Period. Even a few hundred dollars is better than nothing.
Decide Which Investments You Are Going to Use
The TSP is pretty simple in this regard. You only really have six options.
The first option is to just let someone else handle this for you by using a Lifecycle fund. According to the TSP:
The L Funds, or “Lifecycle” funds, use professionally determined investment mixes that are tailored to meet investment objectives based on various time horizons. The objective is to strike an optimal balance between the expected risk and return associated with each fund.
Using L Funds is a simple, easy, and effective strategy that is completely fine for most people. If that is how you want to do it, you can just put all your TSP money in the L Fund with the year that is closest to when you want to retire and skip the rest of this blog post. For example, if you want to retire in 2034, you’d invest in the L 2030.
If you are more of a do-it-yourselfer, then you have five other investment options besides using a Lifecycle fund. The five investment options are listed in this table from the TSP website. Or you can read this booklet that discusses your investment options.
That is really it. You can either use a Lifecycle fund, or one of the five other funds listed in the table or booklet.
The Bottom Line – Decisions You Have to Make
Like we said at the beginning, you have to decide:
- How much you’re going to invest. (Hint: as much as you can afford.)
- What investments you’re going to use – Lifecycle vs do-it-yourself with the five other available funds.
If you decided against the Lifecycle funds, the next thing you have to do is determine your asset allocation, which is our next step to crushing it with the TSP.
Finance Friday Articles
Here are this week’s articles:
Consumer Addiction and 5 Ways to Beat It
Financial Survival As A Resident
How Much Umbrella Insurance Do You Need?
How Should You Invest in Real Estate?
How to Make a Thousand Bucks an Hour
How to Not Worry About Your Money
Investing in Bonds — Back to Basics
Investors Do Better with All-In-One Funds
Learn More About Taxes: Online Courses, Classroom, Books
Understanding The 4 Main Commercial Real Estate Investing Strategies
Will Millennials Get Destroyed During the Next Recession?
Health.mil – Military Health Care Consolidation Moves to Next Phase
Here’s a link to this article:
Throwback Thursday Classic Post – Who’s On Your List?
(It is funny to read this 3 years later, as much of it is true to this day, as you’ll read in my 2019 notes in italics below.)
In my opinion, every Naval physician needs to have a list of people. On this list are the people who you absolutely, positively will not mess with. When you talk to them, you show them the utmost respect. When they ask you for something, you give it to them better and faster than you ever give anyone anything. These are the people who have determined your career path to this point and are likely to continue to steer if for the near future.
Who’s on your list? If you don’t know, you should think about this as soon as you can. You might think it is silly, but I’d actually make a list. Just to show you I’m serious, I’ll share my list (as it was when originally posted on the blog):
- Current Emergency Medicine (EM) Specialty Leader
- Prior Deputy Commander of NMC Portsmouth
- Prior EM Specialty Leader
- Current Director of Medical Services at NMC San Diego
- Prior EM Specialty Leader and Deputy Medical Corps Chief
Why are they on my list? They are Emergency Physicians like me, and they are the most senior and potentially influential people in my career. They are the people who are senior to me, well thought of in my specialty, and get phone calls or in person inquiries when I apply for a leadership position. For example, one of the people on this list thought of me when the Detailer job became available and endorsed me for it. (That same person just made me the incoming Deputy Medical Corps Chief. I show up at BUMED on September 3rd.)
Who’s not on my list? There are no admirals on my list (at least there weren’t at the time – there certainly are now). As a CDR, it is rare that I’m on the radar of an admiral. Some of them know who I am, and some of them could have a major impact on my career path, but it is unlikely that they’ll take a huge interest in my career until I’m a CAPT and qualify for major leadership positions working directly for them (somewhat of a prescient post, I guess). If an admiral wants to know about Joel Schofer, they’ll probably call one of the CAPTs on my list and ask them about me.
Who should be on your list? The people you should consider putting on your list include:
- Your Specialty Leader and prior Specialty Leader
- Your Detailer
- Influential people in your specialty who are 1-2 ranks senior to you
- Whoever is currently in the job(s) you want
Undoubtedly there are other people you should consider, but this list is a good start.
Once you create the list, here are the things you need to keep in mind. Always treat these people with the utmost of respect. You should always treat everyone with respect, but these people get special attention. Never get into an argument with them. I’m not saying you have be a “yes man” (or woman) and agree with everything that they say, but any disagreement needs to be collegial and respectful. You want to prevent them from getting mad at you, if at all possible. When they ask you for something or they give you a task, it immediately rises to the top of your to-do list. In addition, you never give them anything but your best, maximal effort.
The Navy is a large organization that can appear impersonal, but people run it. The people on your list are the ones who are going to determine your future and whether you get want you want or not. If I were you, this is one list I’d put some thought into and actually make.
What’s the biggest worry for military medicine in the next few years?
Here’s a link to an article summarizing VADM Bono’s thoughts as she approaches retirement next week:
What’s the biggest worry for military medicine in the next few years?
August Message from the Assistant Secretary of Defense for Health Affairs
MHS Team:
Earlier this month, the Senate confirmed my nomination as the Assistant Secretary of Defense for Health Affairs. The time I have spent in the principal deputy position has given me valuable perspective on the unique role the Military Health System (MHS) plays in national security and in American medicine. I’m deeply grateful for the opportunity to serve in the ASD role and alongside such a talented team that makes up the MHS.
As I told the Senate Armed Services Committee last November, it will be a great privilege to lead the MHS during this period of unprecedented transformative change. With readiness of our service members as our first priority, we are implementing a historic transition in how we manage our Military Treatment Facilities. We are also conducting comprehensive reviews of the Direct Care System to enhance MTF operations as training platforms to support medical readiness, and identifying the optimal military medical manpower requirements to meet operational requirements. As you know, we continue the deployment of a truly modern electronic health record that will support the provision of integrated, standardized care across the MHS enterprise. Next month, MHS GENESIS will go live at Travis AFB, Mountain Home AFB, NAS Lemoore, and the Presidio at Monterey. This next deployment has been informed by the hard work of the teams at Fairchild Air Force Base, Naval Health Clinic Oak Harbor, Naval Hospital Bremerton and Madigan Army Medical Center during the Initial Operating Capability (IOC) rollout. Earlier this month I had the opportunity to visit COL Thomas Bundt, Commander, Madigan Army Medical Center (MAMC), and his team. Their passionate embrace of the opportunity to be one of the IOC sites has paid off for the entire enterprise. Their contributions to our strategy for future deployment – informed by their lessons learned on the ground – has positioned us for a successful next phase of MHS GENESIS implementation. Thank you, COL Bundt and the entire MAMC team.
In addition to the major reform efforts underway, our day-to-day successes continue to support the Department’s priorities. Earlier this week, I joined the more than 3,000 researchers and scientists from across the Department, interagency, industry, academia, and partner nations at the annual Military Health System Research Symposium (MHSRS).
I spoke to participants about the critical role of military medical research and development in advancing the MHS’s integrated system of readiness and health. From strengthening Traumatic Brain Injury clinical and research capabilities, addressing mental and behavioral health issues among injured service members, vaccines and countermeasures for infectious diseases, to the developments in medical technologies to advance enroute patient care, the MHS’s research and development initiatives enable the U.S. military to remain at the forefront to protect and defend the U.S. homeland and the shared interests of our allies and partners. I encourage you to review the innovative findings coming out of this year’s conference at www.health.mil/mhsrs.
I had the pleasure to recognize a number of MHSRS award winners – awardees like CDR Ian Valerio, who has made pivotal contributions to research on preemptive treatments for phantom and residual limb pain; and the Zika Purified Inactivated Virus WRAIR team, who helped develop a Zika vaccine candidate for clinical trial; and Dr. Amy Adler, whose research in military behavioral health has led to improved outcomes in health, resilience, and performance of service members. It is abundantly clear how the MHS’s commitment to innovation and partnerships is yielding new technologies, processes, and services that help ensure a more prepared, stronger and more resilient force.
A big thank you to Dr. Terry Rauch and the Health Affairs team, RADM Mary Riggs and the R&D team at DHA, Dr. Richard Thomas and his team at USUHS, the Services, and the thousands of scientists and researchers across the MHS who contributed to MHSRS. Thank you for your continued work in advancing the incredibly important mission we are privileged to carry out.
Tom
How Long Do You Have to Stay in the Navy if Executing PCS Orders?
Question: If I execute PCS orders, how long do I have to stay in the Navy before I can retire or resign?
Answer: This is something called “retainability” and is detailed in paragraph 9 (on page 6) of OPNAVINST 1300.15B – NAVY MILITARY PERSONNEL ASSIGNMENT POLICY. Here’s the quick and dirty version.
It all depends on where you’re coming from and going to:
- Coming from OCONUS to CONUS = You must wait 1 year before you can get out of the Navy.
- Going to a CONUS operational billet = also 1 year.
- Coming from CONUS to a shore/non-operational billet = 2 years.
- Going OCONUS anywhere = You must serve the full tour length, which depends on your specialty and where you’re going. I could try to explain tour lengths, but it can get complicated. If you’re not sure what your tour length is, ask your Detailer.
Hometown Hero Program
In order to assist the Navy’s Medical Corps recruiting mission, Commanding Officers have been encouraged to authorize permissive TAD to Medical Corps Officers who engage in recruiting activity.
In other words… if you were planning on taking leave, but spend some of your time helping to recruit for the Uniformed Services University (USU) or Medical Corps Health Professions Scholarship Program (HPSP), you can apply for no-cost TAD and not have to burn your leave. This is a great opportunity for young medical officers to network and build their leave bank.
Process
- Make contact with your alma mater, Medical Officer recruiter, or any optimal group that may be interested in HPSP or USU. Email MedicalVIP.fct < at > navy < dot > mil for assistance. Feel free to email LCDR Brett Chamberlin (e-mail address is in the global) if you encounter any difficulties.
- Develop a plan to recruit, discuss, or generally represent Navy Medicine.
- Request Permissive TAD through your command.
Upcoming Events:
Below are some upcoming USU recruiting events (HPSP recruiting welcome as well). Please contact margeaux.auslander.ctr < at > usuhs < dot > edu
| Dates | USU Event Name | Location |
| 9/25/2019 | Middle Tennessee State University Career Fair | Murfreesboro, TN |
| 9/25/2019 | Rhodes College Graduate School Expo | Memphis, TN |
| 9/26/2019 | Christian Brothers University Graduate School Expo | Memphis, TN |
| 9/26/2019 | University of Memphis Graduate School Information Fair | Memphis, TN |
| 10/1/2019 | Xavier University visit | New Orleans, LA |
| 10/2/2019 | LSU Health Professions Fair | Baton Rouge, LA |
| 10/15/2019 | UT Knoxville Health Professions Fair | Knoxville, TN |
| 10/16/2019 | UIUC Graduate and Professional School Fair | Champaign, IL |
| 10/16/2019 | East Tennessee State University Health Professions Recruitment Fair | Johnson City, TN |
Final FY19 Promotion List is Out – What is the Obligation for Accepting Promotion? What if You Don’t Want the Promotion?
The final FY19 promotion list is out (with my name on it), so it seemed appropriate to answer a few promotion related questions:
Question: What is the obligation for accepting promotion?
Answer: There is no obligation if you end up resigning. If you want to retire, though, the additional obligation is:
- 2 years for LCDR
- 3 years for CDR and CAPT
This can all be found on page 5 of OPNAVINST 1811.3A. Or you can read one of my other posts called “You were accepted for promotion to O5 or O6 – should you accept it?” where I break it all down for you.
Question: What if you want to decline the promotion? The promotion NAVADMIN tells you how to decline it in paragraph 2:
2. If a selected officer does not decline promotion in writing prior to the
projected date of rank (noted above in paragraph 1), that officer is
considered to have accepted the promotion on the date indicated. An officer
who chooses to decline promotion must submit the declination in writing to
COMNAVPERSCOM (PERS-806) within 30 days of the release of this NAVADMIN.
Joel Schofer's Career Planning Blog 