career planning

Tips to Build Your Career During Residency

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Here are the slides I used for this episode of the podcast:

Tips on Building Your Career During Residency

The New Medical Corps Career Progression Slide – What Does It Mean to You?

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Navy Medicine has been undergoing a lot of change. We have a new Surgeon General, a new Corps Chief, and a renewed focus on readiness. With these changes come a new career progression and path for the Medical Corps (MC) Officer (PDF version, PPT version). Let’s take a look at the new model and discuss some of the ways it will impact you as your career progresses. We’ll start at the top of the slide and work our way down, translating it into action items for every MC Officer.

 

Intent and Expectations

What should a MC Officer note in this section? To be competitive for promotion, you need to have been operational AND clinical. The days of camping at Military Treatment Facilities (MTFs) are over. Everyone needs to be operationally relevant, and this is consistent with the most recent changes in the O6 promotion board convening order. It can be with the Surface Force, Fleet Marine Force (FMF), Undersea, Air, Special Operations, Joint environment, Expeditionary Combat Command, or any other operational setting you find yourself in. It doesn’t matter how or in what setting, but everyone needs to be operationally relevant.

Action #1 – Deliberately develop your operational relevance.

 

Recommended Medical and Professional Development Path

Very simply, this spells out your educational pathway. Completing residency and becoming board certified is not a new concept or path for the MC Officer. What is new, though, is the expectation that everyone will serve in an operational setting by the time they are up for promotion to O5 and in a more senior operational role before they are up for O6. The concept of everyone becoming an Operational Medical Officer (OMO) is explained in detail at the bottom of the slide.

In addition to serving as an OMO, the expectation is that those who want to serve in more senior roles will complete Joint Professional Military Education Levels I and II (JPME I/II) and obtain formal management or leadership training, such as a Master’s in Business Administration or similar degree.

Action #2 – Start JPME I now if you haven’t already, and develop a strategy and timeline with your mentors to obtain more senior education.

 

High Reliability Organization Training

The new SG is a huge proponent of high reliability, and Navy Medicine is constantly striving to adopt the principles of a High Reliability Organization (HRO). Many of the classes mentioned on the career path slide are undergoing modifications and updates to incorporate high reliability education.

Action #3 – Attend or complete the listed HRO courses.

 

Example Assignments

The example assignments are divided into Fleet and Navy Medicine Readiness and Training Command/Unit (NMRTC/U) positions. They are also stratified according to the typical ranks at which they would occur. These are general guidelines and variability will certainly occur, so be flexible. For example, we know that it takes a minimum of seven years to become a Neurosurgeon, so their path will vary. Other specialties that require longer training are in a similar situation. As a result of this, we are going to ask each Specialty Leader to take this generic career path and modify it for their own specialty.

Another takeaway from this portion of the slide is to alternate between operational assignments and NMRTC/U assignments where you are serving primarily in a clinical role, likely at an MTF. Time at the MTF will allow you to solidify your individual clinical skills and contribute to our Graduate Medical Education mission. After that tour, return to the operational setting in a more senior role. Rinse and repeat this pattern as your career progresses.

Action #4 – Print the career path slide and get a red and black pen. In black circle the jobs, roles, and courses you’ve already done. In red circle ones you’d like to do. When it is time for your next set of orders, jump from realm where you currently are (Fleet or NMRTC/U) to the other and aim for one of the positions to the right that you circled in red.

 

An Example – My Career Path

Just to visualize the way we are encouraging you to use the career path slide, let’s take a look at My Career Path. I circled the things I’ve done in black, and the things I’d like to do in red.

As a 19 year O6, I have a lot of black ink, but there are some red circles to the right indicating the things I’d like to do. As the Deputy Corps Chief, I am currently in a senior headquarters role toward the right end of the Fleet portion. Most likely, my next career move will be to obtain JPME II or enter Executive Medicine as an Executive Officer (XO) because completing an XO and Commanding Officer (CO) tour is mandatory before I can compete for the more senior leadership roles. Use a similar analysis of where you’ve been (black ink) and where you want to go (red ink) to come up with options for your next career move.

 

Summary

The new MC career path should serve as the basic framework around which you structure your career. A quick summary of the actions you should take include:

  • Deliberately develop your operational relevance.
  • Start JPME I now if you haven’t already, and develop a strategy and timeline with your mentors to obtain more senior education.
  • Attend or complete the listed HRO courses.
  • Circle the jobs, roles, and courses you’ve already done in black. Circle ones you’d like to do in red. When it is time for your next set of orders, jump from the realm where you currently are (Fleet or NMRTC/U) to the other and aim for one of the positions to the right that you circled in red.

Playing the Game and Managing Your Military Career

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What better to do during a global pandemic than listen to a screencast about managing your career! Here are the PPT slides I used for it:

Playing the Game – Managing Your Military Career

March 2020 Medical Corps Newsletter

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Seriously…the March 2020 Medical Corps Newsletter is packed:

  • Message from the Corps Chief
  • Transition from Active Component to Reserve Component
  • Junior Officer Spotlight – LCDR Bridget Cunningham
  • I’m Just a Bill(et)
  • Fresh Whole Blood Transfusion in the 2D Marine Division
  • A Look Back at Navy Physician Astronauts
  • The New Medical Corps Career Progression Slide (PDF version, PPT version) – What Does It Mean to You?
  • Meet the New Career Planner – CAPT Anthony Keller
  • Understanding New Language in the O6 Promotion Board Convening Order
  • Senior Leader’s Interview – CAPT Kim Davis, 4th Fleet Surgeon

Throwback Thursday Classic Post – You Made CDR! Now What?

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If you are one of the lucky people who made CDR, I have some things for you to consider:

  • The next 2-3 years of fitreps may mean very little to your overall career.  First, you are soon going to be in the most competitive group in the Medical Corps, Commanders scratching and clawing to make Captain.  If you are at a medium to large command, no matter what you do as a junior Commander, you are likely to get a P (promotable) on your fitreps.  That is just how it works for most commands.
  • This first bullet means that now is the PERFECT time to do something “alternative” (off the usual career path for a physician) or take a position that you know will get you 1/1 fitreps or be part of a very small competitive group.  Go to the War College.  Take a senior operational job where you’ll get a 1/1 fitrep.  Become a Detailer.  Apply for fellowship because the NOB fitreps won’t hurt you as a junior Commander or Commander Select.  Now is the time to do these type of things.  You don’t want to wait until you are a few years below zone for Captain.  When you reach this stage you’ll need competitive EP fitreps.
  • After you are selected for your next rank is also a great time to move/PCS.  Have you ever been OCONUS?  If not, now would be a great time to go.  You can PCS somewhere for 2-3 years and then PCS to the command where you are going to set up shop and try to make Captain.  At OCONUS commands there is more turnover of staff, so major leadership jobs like MEC President, Department Head, and director positions open up more frequently, setting you up to get a senior position when you return to CONUS.
  • You may think I’m crazy, but it is time to start thinking about how you are going to make Captain.  As I mentioned in the first bullet, getting a job that will make you a Captain is tough and competitive.  Now is the time to do the things that will make you an excellent candidate for one of those jobs.  Want to be a residency director?  Maybe you should get a degree in adult or medical education.  Want to be a director?  Maybe you should get a management degree like a Masters in Medical Management or an MBA.  Want to be a senior operational leader?  Now is the time to do Joint Professional Military Education I and/or II.
  • Here is a list of the jobs that I think will make you a Captain.  Read the list…figure out which of these jobs you are going to use to make Captain…and get busy preparing yourself to get them:
    • Residency Director
    • Department Head in a large MTF
    • Director
    • Chief Medical Officer
    • Officer-in-Charge
    • Major committee chair
    • Medical Executive Committee President
    • BUMED staff
    • Specialty Leader
    • Deployment requiring an O-5
    • Detailer
    • Senior operational leader
      • Division/Group/Wing Surgeon
      • CATF Surgeon
      • Amphib or CVN Senior Medical Officer

Optimally you’ll have the time when you are an O5 to do multiple jobs on the preceding list.  For example, as an O5 I had been a Detailer, a Specialty Leader, Department Head, Associate Director, and CO of a deployed unit.  My next step was to become a director at a major MTF, and while I was a senior LCDR and CDR I obtained a Naval Postgraduate School MBA as well as achieved certification as a Certified Physician Executive to try and make myself a competitive candidate for a director position. Ultimately, I became the Director for Healthcare Business at NMC Portsmouth.

Congratulations on making Commander…take a deep breath…and start thinking about some of the things I mentioned in this post.  Before you know it you’ll be in zone for Captain.

Throwback Thursday Classic Post – FY17 CAPT Board Convening Order Deconstructed

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(Because the convening orders change very little from year to year, this post is still relevant today. Enjoy.)

The FY17 Staff Corps O6 Board Convening Order was released after conclusion of the board.  The best news was that the promotion opportunity for Medical Corps was 70%, up from 50% last year, which was an all-time low.  Aside from that, though, if you read through the convening order, it basically tells you how to get promoted to Captain.  I’ve read through it and pulled out quotes that you can turn into actionable items.  Enjoy:

“Their personal and professional attributes include…physical fitness…”

ACTION ITEM: Workout and never allow yourself to fail a PFA.

“…successful performance and leadership in combat conditions demonstrate exceptional promotion potential and should be given special consideration.”

“The board may give favorable consideration to those officers who have displayed superior performance while serving in IA (Individual Augmentee)/GSA (Global Support Agreement)/OCO (Overseas Contingency Operations)/APH (Afghanistan-Pakistan Hands) assignments that are extraordinarily arduous or which involve significantly heightened personal risk.”

“Success in these assignments [joint duty assignment billets] should be given special consideration…”

“Navy Medicine needs leaders with knowledge and experience in a variety of settings including operational medicine, joint medical operations, and current peacetime health care delivery initiatives.”

“Navy Medicine greatly values joint experience…”

“You must ensure that Navy Medicine’s future leaders possess the broad knowledge necessary to support the operating forces and are acknowledged leaders within their operational…specialties.”

“The officers selected must have demonstrated exceptional managerial skill and professional competence in executive and staff roles both in support of the fleet and Marine Corps and within the naval shore establishment.”

“…you should select those officers who have served in a broad spectrum of assignments requiring expertise in diverse functional areas.”

“…those you select will be placed almost assuredly in positions that require broad military and medical perspectives beyond the Department of the Navy.”

“Best and fully qualified officers for the rank of captain, will be those who have demonstrated experience and expertise across the spectrum of military treatment facilities, operational platforms in support of the fleet or the Marine Corps, and the intersection with the strategic and tactical issues in provision of military healthcare through experience in headquarters or other associated DoD agencies.”

ACTION ITEM: Deploy, preferably in a combat or joint environment, if available.  PCS when you can, and take a variety of assignments, including senior operational positions and positions with other services.

“The board shall give favorable consideration to those officers with relevant graduate education…and Navy and Joint Professional Military Education (JPME).”

“The Navy values completion of graduate education and development of a subspecialty.  Degrees from the Naval Postgraduate School, the Naval War College and equivalent Service institutions, and civilian education programs…are desirable.”

“Navy Medicine greatly values…formal education to include JPME I.”

“The Navy values completion of graduate education and development within and officer’s subspecialty.”

ACTION ITEM: Get a masters degree, do a fellowship, or do JPME I and/or II.

“The Navy values competitive scholarships and fellowships, examples of which include: Olmsted Scholar, Marshall Scholar, Rhodes Scholar, White House Fellowship, SECDEF Corporate Fellowship, and Federal Executive Fellowships (e.g., Politico-Military and Cyber).”

ACTION ITEM: Consider applying for one of these scholarships or fellowships.

“Duty or service in combined or other staff positions at the senior levels of government should also be considered favorably.”

ACTION ITEM: Don’t be afraid to take positions in senior levels of government organizations when they are available.

“You shall give consideration to an officer’s clinical and scientific proficiency as a health professional to at least as great an extent as you give to that officer’s administrative and management skills.  Strong consideration should be given to board certification when a board certification exists for the specialty.”

ACTION ITEM: Get and stay board certified.

Throwback Thursday Classic Post – Normal Promotion Timeline and the Jobs/Achievements That Get You There

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The typical career progression for a Medical Corps officer if promoted on time (the first time they are in-zone) is:

  • 5 years – selected for promotion to LCDR
  • 6 years – promoted to LCDR
  • 11 years – selected for promotion to CDR
  • 12 years – promoted to CDR
  • 17 years – selected for promotion to CAPT
  • 18 years – promoted to CAPT

For example, I’m a 15 year CDR, so I’ll be in-zone in 2 years at year 17.  If I’m selected the first time I’m in-zone, I’ll be promoted to CAPT in year 18. (This just happened!)

There are 5 general career paths in the Navy that lead to promotion, and I firmly believe that all can lead to promotion to CAPT.  They are:

  • Academic
  • Administrative
  • Clinical
  • Operational
  • Research

One of my favorite things about the Navy is that you don’t have to stay within the same career path as you progress in your career.  I have happily jumped around and managed to promote to LCDR and CDR on time.  During my first tour at USNH Okinawa, I was largely clinical.  After that I was academic but transitioned to more of an administrative role, culminating with my time as a Detailer at PERS.  In my current role as Commander of a Joint Medical Group and Joint Task Force Surgeon, I’m both administrative and operational.  My next tour will return me to an academic setting where I hope to score a major administrative role (I became the Director for Healthcare Business) at the command but once again “be academic.”

As you progress down your chosen career path, one of the major determinants of whether you will promote is whether you get the jobs that will allow you to progress to the next rank.  The following lists include many, but certainly not all, of the collateral duties, positions, and achievements you should strive for once you reach each rank.  If you can get some of these positions and do well in them, it should allow you to break out on your FITREPs and increase the chances you will promote.  Of note, in each rank appropriate list there are positions from all 5 general career paths.

LTs or LCDRs looking to promote should focus on achieving these milestones or positions:

  • Getting board certified, which is pretty much a requirement to promote
  • Completing a fellowship, but trying to avoid being a fellow in the years right before they are in zone so that the non-observed FITREPs you often get don’t hurt your chances at promotion
  • Completing a deployment, but again trying to avoid doing it right before you are in zone due to the small competitive groups you often get on your FITREPs
  • Assistant/Associate Residency Director
  • Department Head (DH) is a small/medium military treatment facility (MTF)
  • Assistant Professor at USUHS, which is very easy to get if you just apply.  See my promo prep document for the info on how to do this.
  • Publishing professional publications
  • Research, preferably defense-related
  • Departmental collateral duties
  • Hospital committee member or chair
  • Executive Committee of the Medical Staff (ECOMS) member
  • Civilian leadership positions, like in your specialty society’s state chapter, for example
  • Senior Medical Officer (SMO) or Medical Director in your department at a large MTF

CDRs looking to promote should focus on:

  • Residency Director
  • DH of your department in a large MTF
  • Associate Professor at USUHS
  • Director position (Director of Medical Services, Director of Clinical Support Services, etc.)
  • Officer-in-Charge of a clinic
  • Chief Medical Officer
  • Major committee chair
  • ECOMS member, Vice-President/President-Elect, or President
  • Senior operational leadership position
    • Division Surgeon
    • Group Surgeon
    • Wing Surgeon
    • Commander, Amphibious Task Force (CATF) Surgeon
    • SMO on an amphibious platform
  • Staff position at BUMED
  • Specialty leader
  • Deployment requiring an O-5 or higher
  • Detailer

As a LT or LCDR, I was able to get board certified, complete a fellowship at the right time, deploy twice, become an Assistant Professor at USUHS, publish numerous publications, do some research, obtain numerous departmental collateral duties, chair a hospital committee and be an ECOMS member at USNH Okinawa, become a SMO in the Navy’s largest emergency department, be an Associate Director at a large MTF, and hold numerous civilian leadership positions.

As a CDR so far I have promoted to Associate Professor, been a major committee chair and member of ECOMS, and served a tour as a Detailer.  Currently I’m a specialty leader and am deployed in a senior operational role that required a CDR or CAPT.

All of this took a lot of work, but made it easy for my leadership to fight for and justify early promote (EP) FITREPs that allowed me to promote to LCDR and CDR on time.  Will it work for CAPT?  We’ll have to wait on that (it worked), but the more of these things you can achieve, the easier it will be for your leadership to do the same thing for you.  You need competitive EPs to promote, and doing these things, giving your leadership the ammunition to justify EP FITREPs, is the path to getting them.