GAO Report on Military Medicine
There was a recent Government Accountability Office (GAO) report released that talks about the structure and deployment of military medicine. Here are the 1 page summary and full report, but a summary of its findings is:
The military departments each have their own processes to determine their operational medical personnel requirements; however, their planning processes to meet those requirements do not consider the use of all medical personnel or the full cost of military personnel. Specifically:
- The Department of Defense (DOD) has not assessed the suitability of federal civilians and contractors to meet operational medical personnel requirements. Federal civilians and contractors play key roles in supporting essential missions, i.e. providing operational assistance via combat support. Military department officials expressed a preference for using military personnel and cited possible difficulties in securing federal civilian and contractor interest in such positions. An assessment of the suitability of federal civilians and contractors could provide options for meeting operational medical personnel requirements.
- When determining the balance of active and reserve component medical personnel, the military departments’ processes generally do not consider full personnel costs, including education and benefits. Specifically, officials stated that the Army and the Navy do not consider personnel costs in their assessment of the appropriate balance between active and reserve personnel, and the Air Force’s analysis had some limitations. DOD policy states that workforce decisions must be made with an awareness of the full costs. Further, in a 2013 report, DOD identified the cost of unit manning, training, and equipping as one of five factors that play a key role in decisions concerning the mix of active and reserve component forces. By developing full cost information for active and reserve component medical personnel, DOD can better ensure an appropriate and cost-effective mix of personnel.
The military departments have taken actions, such as establishing policies and procedures, to assess the appropriate workforce mix for beneficiary care within Military Treatment Facilities (MTFs), but challenges remain. The military departments distribute military personnel across the MTFs and then use policies and procedures to consider risks, costs, and benefits to determine how to fill the remaining positions with federal civilians and contractors. However, a number of challenges, including lengthy hiring and contracting processes and federal civilian hiring freezes affect DOD’s ability to use federal civilians and contractors. For example, senior officials at each of the six MTFs that GAO spoke with cited challenges with the federal civilian hiring process, and five of six MTFs cited challenges with the contracting process. As a result, senior officials from five of six MTFs reported discontinuing some services and referring patients to DOD’s TRICARE network of private sector providers or Veterans Affairs facilities. The Military Health System (MHS) is also preparing for the phased transfer of administrative responsibility for MTFs to the Defense Health Agency (DHA), including management of the MTF workforce. According to GAO’s report on agency reform efforts, strategic workforce planning should precede any staff realignments or downsizing. However, according to a senior official, the DHA has not developed a strategic workforce plan. Without developing such a plan, the DHA may continue to face the same challenges experienced by the military departments in executing an appropriate and efficient workforce mix at its MTFs.
Finance Friday
Here are this week’s personal finance articles:
Counting Down (a discussion about end of the year financial housekeeping)
Daylight Robbery (real life stories of bad things financial advisors have done to clients)
Financial CME #8: Test Your Knowledge
Is it Time to Take Some Money Off the Table?
Some Advanced 2018 Continuing Financial Education Reading
The View From Here (a discussion of how you should react to the recent stock market drop)
2019 Female Physician Leadership Course
Here are the documents with information on this course:
Update on the New Fitrep System
The Navy released a NAVADMIN on the upcoming revamped fitness report and evaluation system. Here are the highlights:
- The new evaluation system will place emphasis on merit over seniority or tenure. It eliminates forced distribution with relative ranking against peers in categorized groups within a command and instead rates the performance of a Sailor on paygrade based objective standards. These standards are captured in trait categories that reflect key attributes of professional competence and character.
- Sailors are evaluated on value statements within these trait categories using an expanded 9 point scale for greater accuracy and distinction. The evaluator responds intuitively during a short, timed window when providing a score for each value statement. This approach will apply to both the proposed coaching and evaluation processes.
- The plan is to introduce this new design concept across the entire Fleet with an updated coaching phase while still using the current fitness report and evaluation system before they transition to the new evaluation process. They will deliver the coaching portion of the new system in mid-2019 and the evaluation portion soon after.
- There’s also a PPT slide deck that shows you some screen shots of what the new tool looks like and how it works.
Finance Friday Articles
Recently there was a NAVADMIN about how time is running out to elect the Blended Retirement System (BRS). You have to opt-in by the end of the year if you are BRS eligible.
If you’re not sure if you are BRS eligible, read my article on the White Coat Investor site.
Here are the Finance Friday articles for this week:
A Little Perspective (an article about the recent stock market drop)
Continuing Financial Education (CFE) Week 2018
Deadly Serious (an article about why you need an estate plan)
Disability Insurance For Female Physicians: The Agony Of Defeat
Should You Track Your Net Worth?
Tax Code Changes You Should Know: Deductions, Exemptions, and Credits
The Key To Financial Success As A Doctor – Staying Hungry
WCI’s Fire Your Financial Advisor Course in Action: A Couple Creates Their Financial Plan
POM20 Navy Medicine Billet Reduction
Some of you may have heard that Navy Medicine just had a significant billet cut. This has been referred to as the “POM20” (Program Objective Memorandum 2020) or “divestiture” billet cut. To be honest, the details are all still being worked out, so there isn’t a whole lot of solid information available about this, which is why I haven’t addressed it yet. Here is the high-level overview of what I know right now cut/pasted from the BUMED guidance/messaging sent out to Specialty Leaders:
- Recent decisions by the Department of Defense have resulted in a reduction of military medical department billets across all Services beginning FY 2021, but could occur as early as FY2020. All of the Services’ medical departments will manage their own reductions.
- We expect many of the billet cuts to the Navy medical department will be re-invested in other Navy priorities and communities that increase lethality.
- The Navy Medicine reductions to medical end strength will impact both the Active and Reserve Components. These cuts are NOT related to MedMACRE.
- Currently (as of 7 November), we anticipate potential billet reductions will affect the entire enterprise. The exact number of billets and locations have somewhat been identified but decisions for all of the cuts are still pending. We are sharing the known cuts and are prepared to share specifics as soon as the additional decisions are made.
- The reductions impact our operational medical capabilities (e.g. Expeditionary Medical Facilities), as well as the scope of services available at facilities across the military health system.
- While the specifics of the additional divestiture by Navy Enlisted Classification (NEC) / Officer Specialty and rank / grade mix, have yet to be finalized, we understand some billet changes have already been programmed, which are impacting future assignments.
- At this point, we expect reductions will impact graduate medical education (GME) and other training opportunities and adjustments will be necessary.
- We will not be receiving replacement funding to address these billet reductions.
- While we wait for decisions to be finalized, we’ve started formulating risk mitigation strategies and next steps to include:
- Request partial restoral of POM20 issue cuts; especially Student / Training accounts.
- Re-locate/reallocate platforms across the enterprise to ensure the most efficient and effective readiness placement/posture.
- Working with the Regions to re-balance existing Operations & Maintenance (O&M) funding to ensure essential services are provided.
- Work with the regions to conduct service reduction analysis.
The Best Education You Can Get in the Navy
I’ve done a lot of courses and educational programs during my 17.5 years in the Navy. Here are the best ones I’ve done and why they are so good:
- Advanced Medical Department Officer Course (AMDOC) – This is tops on the list because it is the most useful and educational course with the widest applicability. Everyone should attend AMDOC as early as they can in their Naval career. This is where you’ll learn about BUMED, the Defense Health Agency (DHA), fitness reports, managing your career, and a whole host of other useful topics. While it was always hard to get into the course, it has recently become easier since they shortened it from 2 weeks down to 1 week, doubling the number of courses. You can find info on the course here.
- Naval War College Fleet Seminar Program – This is how I did my Joint Professional Military Education I (which incidentally is one of the best AQDs you can get). I tried to do the on-line Air Force version that everyone said was easier, but I’ve never been less motivated to do anything in my life. When I did the Fleet Seminar Program it was a lot easier because I had a class I had to show up to and classmates I had projects we were working on. It was also a lot more interesting to have discussions with folks of all backgrounds than doing it by myself on-line. You can read about it on their website.
- Naval Postgraduate School Executive MBA Program – This allows you to get a defense focused MBA in 2 years. The commitment is 3 years from the time you finish or quit, and it doesn’t interfere with your medical special pays. It is accredited as a standard MBA program, so you get all the usual MBA content you’d expect (finance, accounting, etc.), but there is a defense focus. This means that you take a class on funding the DoD and 2 semesters about how to purchase weapons programs. The weapons acquisition class was the least fun part of the degree for me, but I was warned ahead of time so I knew it was coming. I combined this non-medical MBA with the Certified Physician Executive courses to learn medical related leadership principles in addition to standard business principles. The work isn’t hard, but it is time consuming and about 10-20 hours per week. Overall, I’d highly recommend this program as you get a quality MBA for only the cost of books.
- Interagency Institute for Federal Health Care Executives (IFFHCE) – This is a very senior level course that is filled with O6 and the equivalent personnel from all branches and governmental agencies. When I attended I was a senior O5 and was the among the most junior in the class. You get exposed to all sorts of very influential speakers who are experts on their high-level strategic topics. It is tough to get into this class, but if you can go I’d highly recommend it.
- MHS Medical Executive Skills Capstone Course – This is similar to the IFFHCE (#4 above). It is senior and strategic. The course topics overlap, but both are excellent.
- MedXellence – This is a course run by the Uniformed Services University that they take on the road. You can often find that the course is coming to your area and sign up when it is local. This course is senior and more operational/tactical than the last 2 courses. It is for those interested in the business aspects of Navy Medicine, like clinic managers, department heads, OICs, Directors, etc. It is similar to an advanced clinic management course.
- Naval Justice School Senior Officer Legal Course – This course is for anyone who has Executive Medicine in their future. You will learn about legal challenges that senior leaders face in a case-based and enjoyable format. I was able to get into the course pretty easily as an O5. You don’t have to be slated to be an XO.
- Lean Six Sigma – If you are at a medium-large command, you should have someone somewhere that is the command’s Lean Six Sigma black belt. You may even have an entire office dedicated to it. I’ve done the green belt certification and taken the black belt course but never completed the full black belt certification. If you want an introduction to process improvement, start taking LSS classes available to you at your command.
- Medical Management of Chemical and Biological Casualties Course – I took this course a long time ago when I was a GMO, but it was great then and probably is still great. You get to go to the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID). This is probably of even greater relevance lately due to all of the Ebola outbreaks.
- TRICARE Financial Management Executive’s Program (TFMEP) – This is another road show similar to MedXellence. You can find the course info here. I’d highly recommend this to anyone who is looking to rise to the senior levels of leadership at any MTF.
- Joint Senior Medical Leader Course (JSMLC)
- Joint Medical Operations Course – I did these last 2 courses back-to-back at DHA before I was deployed as a Joint Task Force Surgeon. They were a good introduction to the world of joint operations, but not among my favorites, which is why they are at the bottom of the list. If you want to be introduced to the world of joint publications and find out if “joint” really means “Army” have at it!
I’m sure there are other great courses available in the Navy, but these are the ones I’ve done that I found useful. If you have others you’d suggest, post them in the comments section.
Naval Postgraduate School Executive MBA Program Announcement
Here’s the article about the Naval Postgraduate School Executive MBA that I did:
Distance Learning Degree, Certificate Opportunities Announced
From Chief of Naval Personnel Public Affairs
WASHINGTON (NNS) — Navy announced Naval Postgraduate School (NPS) distance learning defense-focused master’s degree program opportunities for fiscal year 2019, including the Executive Master of Business Administration (EMBA) and graduate certificates, in NAVADMIN 275/18, Nov. 15.
These distance learning programs enable students to earn certificates or degrees at locations across the nation and around the globe.
NPS distance learning programs are part-time programs, normally lasting 12 to 24 months for officers, Department of Defense (DoD) civilians and some DoD contractor personnel who are unable to attend NPS residential graduate programs.
Distance learning master’s degree programs consist of one or two classes per quarter, for eight or nine quarters.
The EMBA is a 24-month, part-time online graduate program focused on financial resource management. This fully funded program targets middle to senior-grade active-duty officers, lieutenant commander (select) and above (lieutenant by waiver).
Admission to the EMBA program is available to applicants in any geographic location. The application deadline for the spring 2019 program is Dec. 7, 2018, with online instruction beginning April 2019.
Naval officers completing the EMBA are awarded the 3100P subspecialty code (NOTE – Medical Corps officers can’t hold this subspecialty code because there are no billets that require it). Officers interested in the EMBA program can visit the NPS EMBA home page at www.nps.edu/emba for detailed eligibility requirements.
All officers who enroll in a NPS distance learning master’s degree will incur a 2 to 3-year service obligation upon course completion/withdrawal, and all who enroll in a NPS certificate program will incur a 1-year service obligation upon course completion/withdrawal.
Copies of transcripts and participation agreements are required to support the application process for all degree programs.
Distance learning graduate certificates consist of a series of four graduate level courses delivered over four quarters, designed to provide enhanced knowledge and skills in specific subject areas. Graduate certificates are also available to qualified enlisted personnel. DoD contractor personnel applications will be considered for admission on a space-available basis.
A complete list of distance learning programs can be found at http://www.nps.edu/web/DL/. Each program’s webpage has the prerequisites and eligibility requirements for enrollment.
NPS is dedicated to providing relevant, high quality education to empower the next generation of leadership in the DoD, using a variety of delivery methods to expand learning beyond the traditional classroom.
For more information on NPS’s distance learning opportunities, read NAVADMIN 275/18.
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