This is my first videocast of a lecture I gave to the Emergency Medicine residents at NMC Portsmouth a few weeks ago. I was surprised by how many questions there were about special pays. I think it is a topic that is mundane to those of us that have been in the Navy for a while, but can be quite a mystery to new Medical Corps officers. As I learn how to videocast I’m sure the content will improve, but aside from one place where I said “January” instead of “July” I think it turned out well. I hope junior physicians enjoy this introduction to the world of Medical Corps special pays.
When discussing why they failed to promote, one of the more common reasons that officers give is that they were unable to get a leadership position. When I ask them how they prepared themselves for these positions and what they did to improve their chances of getting one, they often don’t have much to say. Frankly, they didn’t do anything “extra” or above and beyond their normal duties to prepare for and get a leadership position.
Don’t be one of those officers.
The recipe for promotion is fairly simple. Superior performance in leadership positions leads to early promote (EP) fitreps, which leads to promotion. As promotion gets more difficult, the competition for leadership positions is likely to increase, and officers need to find a way to differentiate themselves from the crowd, increasing the chance they’ll get leadership positions. Obtaining a master’s degree can be one of the things that will distinguish you from other physicians and can dramatically increase the chances that you are competitive for career advancing positions.
What Kind of Degree Should You Consider Getting?
This depends on your career goals. If you want to become a leader in research or global health engagement, an area of increased focus in the Navy, you probably want to get a Master in Public Health (MPH) or similar degree. If you want to become a residency or fellowship director, a master’s degree in adult or medical education would fit the bill. If you want to become an operational leader, attending a war college would make sense. And if you want to become a clinical administrator or pursue executive medicine, obtaining a management degree, such as a Master in Business Administration (MBA), Master in Medical Management (MMM), or Master in Healthcare Administration (MHA), would make sense to me.
How Can You Get a Master’s Degree While on Active Duty?
There are many ways you can do this, but the most common include:
- Complete a fellowship that includes a master’s degree. Some fellowships either include or have the option of obtaining a MPH, such as the Global Emergency Preparedness and Disaster Response Fellowship. I also know of multiple officers who asked the Graduate Medical Education Selection Board for an additional year of fellowship to obtain a degree or simply for permission to obtain a degree alone. What are the chances this will be granted? Well I’m sure the chances change from year to year, but they are zero if you don’t ask.
- Complete the distance learning Executive MBA from the Naval Postgraduate School. This is how I got my MBA for the cost of books alone, and I think the program is excellent. You have to go to Monterey for 1 week at the beginning of the 2-year program, but after that all classes are held in person at remote sites via video conferencing. You have to have 2 years of time-on-station left at your current command, so you have to apply to start right after you get to a command or get a new set of orders. In addition, your CO has to sign a letter stating that you’ll get the time to attend classes once per week for 8-9 hours and that you are not slated to deploy. You can deploy once you start the program, but you can’t be on the hook when you apply.
- Use Navy Tuition Assistance (https://www.navycollege.navy.mil/ta_info.aspx#eligibility) to pay for a degree. The tuition rates they pay will not completely cover more expensive degrees, but every little bit helps.
- Apply for the Navy Career Intermission Program and take time off to get a degree.
- Attend a war college. Intermediate colleges are for officers who are O4 or below, while senior college is for O5 and above. If you’re interested, contact your detailer.
- Pay for it yourself and do it in your free time on-line or in person. One program to look into is offered by the American Association for Physician Leadership (http://www.physicianleaders.org/education/programs/masters). By taking some CME you can then enroll in various patient safety and management degrees that are all physician focused. The on-line University of Massachusetts healthcare focused MBA that they offer is the most reasonably priced MBA that I could find that is accredited by the top business school accreditation body. If you want a fast MBA (but pricey), look into the University of Tennessee Physician Executive MBA program (http://pemba.utk.edu).
While committing to a master’s degree program will take major time and effort, that is the point. It is a well-recognized way to demonstrate to the Navy that you’ve made a serious commitment to your professional development and could go a long way toward giving your next interview for a leadership position.
Here is the recently released NAVADMIN for the BUMED XO/CO Screening Board. Applications are due by 7/31/15 to be considered. Although only Captains can apply, anyone contemplating a future in executive medicine should take a look at the NAVADMIN and the references it points you to so that you have an idea what kind of things you need to do to be considered.
My June 13th post that discussed whether CDR is the new terminal rank and other O6 promotion board takeaways has gotten the most attention thus far. I received some questions about what happens when you are passed over for promotion and are now “above-zone.” If you ever find yourself in this position, here is what you need to do:
- Realize that it is not the end of the world. As we’ve previously discussed, more and more people are getting passed over, and a good number of them eventually are selected for promotion. In FY15, 36% of LCDRs who were above-zone were selected for promotion to CDR. When it comes to CAPT, the above-zone selection rate was 11% in FY14, 10% in FY15, and 7% in FY16. While those promotion rates are particularly depressing for above-zone CDRs, you have to realize that there is a significant portion of CDRs who have given up and stopped trying to promote to CAPT but are still included in the denominator of the above-zone selection rate. Because of this, I think if you try to get promoted your chances are better than the aforementioned 7-11% above-zone selection rate.
- If you do nothing, you will continue to get looked at for promotion boards until you retire, resign, or are forced out of the Navy. There is no limit on the number of chances you get to promote and your record will be evaluated for promotion every year. That said…
- You need to try to promote. At a minimum you need to send a letter to the promotion board. What do you say in this letter? First, briefly state that you want to be promoted and that you desire to continue your career in the Navy. Second, briefly explain what a promotion would allow you to do that you can’t do at your current rank. Answer the question, “Why should they promote you?” For example, if you want to do Executive Medicine you need to be an O6, so tell them that you want to screen for XO. If you are a LCDR and you want to be a Department Head at a large MTF or a Residency Director (or whatever you want to do), tell them that you need to be promoted to CDR to be competitive for these jobs. The Navy wants to promote leaders. Make it clear to them that you are a motivated future leader.
- Try and get letters of support to attach to your letter. These letters should be from the most senior officers who can personally attest to your value to the Navy. In other words, it is probably better to get a letter from an O6 who knows you well than a 3 star who doesn’t. If you are not sure who to ask for letters, ask those more senior to you or your Detailer for advice. Your Specialty Leader is always someone to consider if he/she knows you well and can speak to your contributions to the specialty and Navy.
- Have your record reviewed by your Detailer. Because of promotion board confidentiality, you and your Detailer will never know the reason(s) you did not promote, but most of the time the Detailer can come up with an educated guess. They’ll often find things that you were not even aware of, like potentially adverse fitreps, or information missing from your record. My promo prep document will help you as well, which is available at the top of this webpage.
- Do everything you can to get “early promote” or “EP” fitreps. This is largely accomplished by continually striving for positions of increased leadership. You need to get a job that has historically led to promotion. If you are a LCDR who got passed over for CDR, try to get one of these jobs and excel at it:
- Assistant/Associate Residency Director
- Department Head at a small/medium sized MTF
- Senior Medical Officer or Medical Director
- Chair of a hospital committee
- ECOMS member
If you are a CDR who got passed over for CAPT, try to get one of these jobs and excel at it:
- Residency Director
- Department Head in a large MTF
- Associate Director or Director
- Officer-in-Charge (OIC)
- ECOMS President
- Division, Group, or Wing Surgeon
- CATF Surgeon
- Specialty Leader
These lists are not exhaustive and are not the only paths to CDR or CAPT, but they are a good start.
- Meet with your chain-of-command. After you’ve been passed over is not the time to be passive. You need to sit down with your leadership and get an honest assessment from them of how you’re doing and what they would recommend to continue to advance your career. You may not like what you hear, but it is better to find out early if they don’t think you’re doing a good job or that you are unlikely to break out on your fitreps. That way you can try and put yourself in a better situation by changing commands.
In addition to the above list of things you should do, there are a few things you should not do:
- Do not lie in your letter to the board. In other words, don’t tell them you want to do Executive Medicine if you don’t really want to. Your record reads like a book, and if it tells a story that is contrary to what your letter says, this is unlikely to help you and may hurt you.
- Do not send long correspondence. Promotion boards have to read everything sent to them, and a long letter may not be appreciated. Keep it brief and to the point.
- Do not ask your current CO to write you a letter to the board if they’ve done an observed fitrep on you. His or her opinion about you should be reflected on that fitrep, so they don’t need to write you a letter. If they’ve never given you an observed fitrep or there is some new information not reflected on prior fitreps, they could either write you a letter or give you a special fitrep. Ultimately it is up to them whether they do either of these or none.
- Do not discuss anything adverse unless you want the board to notice and discuss it. This issue comes up frequently and people will ask me for advice, but ultimately it is up to the individual officer. The one thing I can guarantee is that if you send a letter to the board and discuss something adverse, they will notice it because they will read your letter! If you think there is a chance the adverse matter will get overlooked, it is probably better not to mention it and keep your fingers crossed.
Those are my tips for those who find themselves above-zone. Most importantly, if you want to promote, NEVER STOP TRYING. I personally know of people who got promoted their 4th look and have heard of people who succeeded on their 9th try!
In case you haven’t figured it out yet, it is getting harder to promote to Captain. Here are the historical promotion opportunities for O6. You don’t have to be a mathematician to notice the trend:
There are a lot of physicians who came into the Navy when it was relatively easy for a physician to promote to Captain. If you could fog a mirror, you could likely promote. Well…things seem to have changed.
This has frustrated some physicians who failed to promote and is likely to frustrate more in the future. Aside from getting frustrated, though, it would benefit all involved if they could learn from this trend and try to adjust while there is still time. Here are my O6 promotion board takeaways:
- It is now normal when you fail to select for Captain the first time. In the FY16 board only 39% of Commanders who were in zone were promoted, leaving 61%, a clear majority, who did not. Physicians should expect to fail to select or “get passed over” the first time they are up for O6.
- Commander is the new terminal rank for full-time clinicians, and there’s nothing wrong with that. If the thought of taking on a significant collateral duty makes you want to cringe because you want to remain a full-time clinician during your time as an O5, you have likely reached your terminal rank. Physicians get very frustrated when they fail to promote to O6, thinking that the Navy doesn’t value clinical productivity, and this is just not true. The Navy does value clinical productivity, it just doesn’t think that they need to be Captains! The Captain rank has moved from being a reward attained by most physicians who hang around long enough to a reward for those with senior leadership potential.
- The overwhelming majority of Commanders who promote to O6 take on a significant collateral duty. Whether they were a department head at a large MTF, a specialty leader, a residency director, a director, president of ECOMS, or in a senior operational role, they all had to pay their dues in these roles in order to score the EPs on their fitreps that allowed them to promote. These roles almost always necessitate a reduction in clinical activity, which is why you are less likely to promote to O6 as a full-time clinician.
- Having only one competitive EP fitrep before the promotion board is often not enough. At some of the larger MTFs it can take quite a while to “break out” from the pack of Commanders and get an EP on your fitrep. If you are lucky enough to get an EP but you only slide one in before you are in zone, it may not be enough. As the competition heats up, it is the people with multiple competitive EPs that will be in the best position to promote.
- You need to demonstrate career diversity while not hurting your chances to promote. The best time to mix it up is right after you are selected for Commander. You are finally senior enough to get a decent position at an operational command, BUMED, PERS, or some other alternative command. If instead of mixing it up you stay were you are, you will be the new, small fish in the largest pond in the Navy, the Commander fitrep competitive group. No matter what you do you are probably going to get promotable fitreps for a few years. You might as well use those years to break things up, PCS (even locally to an operational command – I’m not saying you have to move), and demonstrate to the Navy that you are willing to flex for the needs of the Navy. You may get 1/1 EP fitreps but while you are a junior commander this is unlikely to hurt you. Then once you are done with that tour, you can return to a larger competitive group and compete for one of the aforementioned jobs if you have making O6 on your radar.
There are many important dates in your Navy career. One of the most important and neglected dates, though, is your projected rotation date or PRD. Your PRD is the month and year that your current orders will expire and you are scheduled to rotate to a new command. If you don’t manage your PRD and pay close attention to it, you can find yourself with few career options and in a situation you never thought you’d be in. With that in mind, here are my tips for managing your PRD.
First, know when it is because many physicians don’t know their PRD. If you are in this crowd, the easiest way to find your PRD is to login to BUPERS On-Line and look at block 14 of your Officer Data Card:
The other way to find your PRD is to contact your detailer because they can look it up in the detailing system. Many physicians don’t know their detailer, so here is a link to a page with “Contact Us” in the middle. That link will take you to your detailer’s contact info, but note that it is CAC protected:
Once you know your PRD, the easiest way to manage it is with whatever calendar you use (an app, web calendar like Google Calendar, Outlook, a date book, etc.). Place reminders in your calendar to correspond with these time frames:
13-18 MONTHS BEFORE YOUR PRD – This is when you should start thinking about your next career move. Although the normal time period to request an extension (find a template here) at your current command is 9-12 months before your PRD, many physicians request an extension during this time period if they are sure they want to extend. This is also a great time to talk to the operational detailer about operational billets you might have interest in or the senior detailer about what I’ll call “alternative billets” like those at DHA/BUMED, BUPERS, global health engagement billets, NAVMEDWEST, NAVMEDEAST, etc. If you act on your PRD in this timeframe, you’ll be well ahead of the game.
9-12 MONTHS BEFORE YOUR PRD – This is the traditional detailing window where you contact your detailer and specialty leader to negotiate your next career move. This is when physicians normally submit an extension request as well as explore potential billets for their next set of orders. The one caveat is that the availability of billets is often contingent on the results of the Graduate Medical Education Selection Board or GMESB. Since these results are not finalized until January, people with summer PRDs will find that they may have to wait beyond this time period to find out what billets are available and get orders.
6-8 MONTHS BEFORE YOUR PRD – This is when the list of billets that are actually available will solidify and most physicians will get orders. If you want to extend at your current command and you haven’t submitted an extension request yet, you should do that ASAP.
1-5 MONTHS BEFORE YOUR PRD – Many physicians will get into this period without orders. If it is because you were waiting on the results of the GMESB, you are probably fine. If you are in this period for another reason, you should get nervous. The truth is that unanticipated things always happen. Commanding Officers don’t endorse extension requests. Unanticipated openings cause a detailer and specialty leader to have a “hotfill” billet. When things like this happen, a detailer goes looking for officers close to their PRD to fill the need. If you are in this window without orders, you are low lying fruit for filling these needs. And just so you know, most of these “hotfills” are not in Rota or San Diego.
AT YOUR PRD OR BEYOND – Physicians let their PRDs pass all the time. Sometimes it is because they submit an extension request that never gets approved because it gets lost somewhere in the process. Other times they don’t know when their PRD is. Realistically, there is often no consequence if your PRD “expires,” although some commands will pick up on this fact and get your attention by threatening to take away your computer access. The biggest threat, though, is the aforementioned “hotfills” that inevitably show up. If your PRD is expired, you are going to rise to the top of the list when the detailer goes looking for people to fill that need. Have fun wherever that “hotfill” is.
THE BOTTOM LINE – Know when your PRD is and manage it according to the above timeline. This will give you the maximum chance of getting what you want and reduce the chance that you are selected for a “hotfill” you don’t want.