Many Medical Corps officers don’t understand the difference between their Specialty Leader and their Detailer. After you read this post, this won’t be a problem.
DIFFERENCE #1 – WHO THEY WORK FOR
A Specialty Leader works for Navy Medicine (BUMED), the Surgeon General, and the Medical Corps Chief while a Detailer works for Navy Personnel Command (NPC or PERS). NPC/PERS is a line command, while BUMED is obviously medical. This difference is probably not of significance to the average Naval physician, but it can make a difference at times because these two commands (and people) will look at things from a different perspective.
For example, let’s say you are one of two subspecialists at NMC Camp Lejeune and you have a fairly light clinical load. You decide you want to leave early to get to your next command, Naval Medical Center Portsmouth (NMCP), because they are actually down one provider in your specialty due to the illness of another member of your community. Your Specialty Leader will probably endorse this early move because it makes sense. You are underemployed at Lejeune and there is a need at NMCP.
Your Detailer, however, will look at it differently. First, you haven’t served your full tour, so moving you early will require a waiver that may be denied by PERS. This largely has to do with money and PCS rules and has nothing to do with your specialty or the needs of the Navy. I’m not saying that Detailers don’t care about the needs of the Navy because they do, but they are constrained by the rules of PERS while a Specialty Leader is not.
DIFFERENCE #2 – WHAT THEY DO
A Specialty Leader serves as a liaison between you, BUMED, and your specialty as a whole. He or she also coordinates deployments, although the control they have over this was lessened by the return to platform-based deployments (deployments determined by what billet you are in or what unit/platform you are assigned to rather than whose turn it is to deploy). They also serve as a consultant both to you and your Detailer when it comes to career management and PCS moves.
A Detailer is your advocate to help you advance in your career, prepare for promotion boards by improving your officer service record, and negotiate orders for your next PCS. They will often speak with both you and your Specialty Leader while trying to balance your needs with the needs of the Navy. They also are the final approval authority for extension requests and actually write your PCS orders.
DIFFERENCE #3 – WHAT THEY DON’T DO
Specialty Leaders do not write orders. Many physicians think that the Specialty Leader is the one who decides what orders they get and where they PCS, but the reality is that Specialty Leaders can’t write orders. Only Detailers can, therefore it is the Detailer who makes the final decision in nearly all cases. If there is a good Specialty Leader-Detailer relationship, most of the time both are in agreement and there is no controversy, but about 5% of the time there is at least some level of disagreement that has to be worked out.
Detailers can write your orders to a command, but they do not influence who gets command-level leadership positions. For example, you may want to go to Jacksonville to be the Department Head of your specialty’s department. A Detailer can write you orders to Jacksonville, but which physician the command picks to be Department Head is up to them, not the Detailer (or the Specialty Leader).
Specialty Leaders will often talk to commands, but Detailers usually do not. The Detailer is SUPPOSED to talk to three people – you, the Specialty Leaders, and the Placement Officers. The Placement Officers are officers at PERS who represent the commands. You can think of them as the detailers for commands. They make sure that commands aren’t taking gapped billets, that the providers sent to the command meet the requirements of the billet they are entering, and weigh in on other issues like extension requests.
I say that a Detailer is SUPPOSED to talk to three people and USUALLY does not talk to commands, but the reality is that commands frequently call the Detailer instead of talking to their Placement Officers. This often happens because the Director at a command knows the Detailer but doesn’t know the Placement Officer. In addition, the Detailer is usually a physician (3 of 4 Medical Corps Detailers are physicians, the 4th is a MSC officer) and the Placement Officer is always a MSC officer. Physicians like talking to other physicians.
Finally, Specialty Leaders do not alter your officer service record. In fact, unless you send it to them, they can’t even see it or your FITREPs. Detailers, on the other hand, can see just about everything and can update/change some things, mostly additional qualification designators or AQDs.
WHY SHOULD I CARE ABOUT ANY OF THIS?
Because you must actively manage your career to get what you want. This means you should talk with both your Specialty Leader and Detailer 9-18 months ahead of your projected rotation date (PRD). You should discuss your short and long-term goals, whether you want to PCS or extend, whether you are planning a Naval career or want to resign or retire, your family situation, and your medical situation if applicable.
Most importantly, though, is to be honest with both your Detailer and Specialty Leader. Most Specialty Leaders get along well with the Detailer, so if there is any disagreement between the three of you make sure that you keep things professional and respectful at all times. It’s a small Navy and, to be honest, it will be readily apparent if you are playing one off against the other.
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.)
There are many career paths available to Medical Corps officers. The five primary career paths include:
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.
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.
(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.
Billet Title: Career Planner, Office of the Medical Corps Chief, BUMED
Location: Navy Bureau of Medicine and Surgery, Defense Health Headquarters,
Falls Church, VA
Corps: Medical Corps
Tour Length: 36 months (beginning JAN-FEB 2020)
Mission: Mentor and guide all USN Medical corps officers providing leadership and career development support and guidance. Integral to selecting and maintaining a competent and professional Medical Corps which is valued by the organization and meets the needs of the mission and the strategic goals of readiness, health, and partnerships.
Functions: Mentors and provides leadership development opportunities for Medical Corps Officers. Serve as president of the Professional Review Board, responsible for accessions of MC Officers via FAP/TMS/DA pathways. Responsible for reviewing litigation reports quality assurance reports in determination of NPDB reporting. Plans and coordinates the annual USN MC GME/Operational Intern Road Show. Medical Corps Chief Office liaison to all other Corps Career Planners and Leadership/Career Development Working Groups. Subject matter expert on accession issues pertinent to MC Officers. Serves as member of multiple councils and boards including Medical Education Planning Council and HPSP selection boards. Provides regular AMDOC, ODS, and command-requested briefings relative to the Medical Corps.
Command Relations: Ability to communicate effectively to a 1 or 2 Star Admiral on a regular basis.
Experience Required: Highly recommended to have: Knowledge of Department of Defense, Navy, Navy Medical Corps policies and instructions and policies of other Federal entities as needed; Experience with recruitment, retention, promotion, and sustainment of Medical Corps Officers; Proficient networking, written and oral communication, and public speaking skills.
Other: Time available to perform clinical work at multiple MTFs in the National Capital Region. Time available to travel for CME. TAD travel possible throughout the year for Medical Corps Chief related events.
POC: CAPT Chris Quarles (contact info is in the global) by 29 JUL 2019 with Specialty
Leader and Detailer concurrence. All candidates must be eligible for PCS orders. Preferred report date is JAN 2020.
NOTE: CV, BIO, and Letter of Intent needed for application. All candidates must be eligible for PCS orders.
When you start your Naval career, the future is largely a mystery. As you progress is your career, things will crystalize, you’ll become wiser, and you’ll think, “It would have been nice to know all of this in the beginning.”
I’m going to try and tell you what you should have known about career progression and promotion board math from the beginning.
This diagram below demonstrates the typical career progression of a Medical Corps officer who has no prior service. Assuming you are not picked early for promotion, you typically promote every six years. You will become a Lieutenant Commander (LCDR) at approximately 6 years, a Commander (CDR) at 12 years, and a Captain (CAPT) at 18 years. I had no prior service, I have never been promoted early, and this is exactly the timing I experienced in my career.
Along the left are the ranges of promotion opportunity for each rank from fiscal year 2013-2020. In each year, the promotion opportunity for LCDR has been 100%. In theory, if all the Lieutenants are suitable for promotion they can all be promoted to LCDR. When it comes to the promotion opportunities for CDR or CAPT, interpreting them is a touch more difficult because we have to talk about promotion board math.
Promotion Board Math
In Fiscal Year 2019 (FY19), people were very excited about a 90% promotion opportunity for the FY19 Staff Corps O6 promotion board. But it was easy to misinterpret this opportunity. It did not mean that 90% of CDRs were selected for CAPT.
Where Does the Promotion Opportunity Come From?
The short answer is from manpower projections. How many physicians are getting out or retiring? What is the current Medical Corps manning level for that rank? What are future needs anticipated to be? What is the size of the promotion zone? The answers to all of these questions determines the promotion opportunity and guide Navy Personnel Command (NPC) and the Bureau of Medicine and Surgery (BUMED) when they are making their decision.
As you can see here, the promotion opportunity varies from year-to-year:
Historical promotion opportunities for FY13-20.
But as you can see here, the percentage who are promoted from the in zone group is substantially lower:
Historical percentage of in-zone candidates selected for promotion for FY13-20.
Promotion Board Zones
There are three “zones” for promotion – below zone, in zone, and above zone. Medical Corps officers are below zone for two years, in zone for one year, and above zone until they are either selected for promotion or get out of the Navy. A few people are usually picked early or below zone, but most people will not get picked until they are in or above zone.
FY19 O6 Promotion Board Math
In FY19, there were 74 CDRs in zone for promotion. To figure out how many officers can be selected for promotion, you have to multiple the zone size by the promotion opportunity. For example, if you take the 90% promotion opportunity everyone was excited about and multiply it by the zone size of 74, you’ll see that they could have promoted 67 CDRs to CAPT during the board:
90% opportunity X 74 people in zone = 66.6 (rounded up to 67) people they can pick for O6
These 67, though, were picked from CDRs who were below zone, in zone, or above zone. Usually, there is a small number picked from below zone, and a much larger number from the in zone and above zone categories. Here were the results:
As you can see, the 90% promotion opportunity only led to a 41% selection rate for those who were in zone. The remainder came from the below and above zone CDRs.
The Bottom Line on Career Progression
The typical career progression occurs with a promotion every six years, as detailed in the diagram below. The promotion opportunities listed, though, result in a much lower chance of getting picked when you are in zone because the selections come from those below, in, and above zone.
Here’s a link to the article: