career planning

Up-or-Out Promotion Reform Stalls

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Assuming they haven’t been prior enlisted, the current up-or-out rules will force officers out of the Navy at the following points:

  • LT – separated if you fail to select twice
  • LCDR – 20 years
  • CDR – 28 years
  • CAPT – 30 years

If an officer has prior enlisted time, the length of time you can stay in the military if you fail to promote is a complicated calculation and your Detailer is the best person to talk to about it.

One of the promotion reforms that has been recently discussed is a change to this up-or-out system.  The argument in favor of the reform says that these rules force officers out of the military who both want to serve and possess valuable skill sets.  In my experience, this can be true.  I’ve seen physicians in undermanned specialties who wanted to stick around but could not due to these rules.

This article from Military Times gives you the details on how efforts to reform the up-or-out rules have stalled:

The Pentagon’s Up-or-Out Promotion Reform Stalls Amid Internal Divide

FY17 CAPT Board Convening Order Deconstructed

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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.

Normal Promotion Timeline and the Jobs/Achievements That Get You There

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(Here are some Military Career Progression Slides from a career planning lecture I often give to accompany this post.)

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.

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 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
  • 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, 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.

Highlights of BUMED Specialty Leader Business Meeting

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I was recently selected to be the Emergency Medicine Specialty Leader, and earlier this week I attended the BUMED Business Meeting for Specialty Leaders and Program Directors.  Below are the highlights I thought were of interest to a general Medical Corps audience:

  1. BUPERS is removing the AZ (above zone) and IZ (in zone) stamps on the Officer Summary Records (OSR) for all promotion boards starting with the upcoming FY17 promotion boards.  Some feel that when officers are labelled “AZ” that board members assume that something must be wrong with them since they failed to select previously.  This is being done to reduce the chance of that bias (if it even really exists).  Obviously if you have been passed over for promotion and you have a ton of FITREPs at your current rank or the board members closely scrutinize your date of rank on the OSR, they will be able to figure out pretty easily that you are AZ, but without the stamp it will make it harder for them to do so.
  2. There is a POSSIBILITY that they change the promotions in the future so that the top 10% of officers selected for promotion get to put the new rank on first.  Currently the order your promote is based on your lineal number and seniority.  In other words, the officers who have been passed over most get to put the new rank on first.  They MAY switch to a system where merit determines who promotes sooner rather than seniority.
  3. DMHRSi is something that very few Medical Corps officers like, but you should realize that the data you put into it is clearly used by BUMED to make decisions that impact manning and measure your productivity.  You should do what you can to correctly reflect your workload in DMHRSi.
  4. The rollout of the new electronic medical record is slated to begin in the Pacific northwest in 2016, but it MIGHT be pushed to the right into 2017.  The total rollout is scheduled over a 5 year period.
  5. The career intermission program is being expanded.  You can use it to take up to 3 years off, essentially hitting the pause button on your career.  You retain 1/15th of your basic pay and your benefits, like TRICARE, and will owe a 2 for 1 time to the Navy upon your return.  For example, if you take 2 years off, you’ll owe 4 years when you return to active duty.  When you return, your lineal number and promotion cycle is reset so that you don’t lose any time and you jump back into a year group that you can compete with for promotion.  There is info on the program here, OPNAV 1330.2B – Navy Career Intermission Program Guidelines or at this website.
  6. The conference approval process is arduous and painful, but it MIGHT be getting easier.  For now it will remain the same and require multiple forms.  If you are going to something that is a “course” and not a “conference” then your Specialty Leader can see if BUMED legal will exempt the course from the approval process.  The POC in that office says that courses have been exempted successfully, and once they are exempted then all officers can use that exemption if their command is willing to pay for the course.  Here is the conference approval webpage.  You should always check here for the latest information.

Specialty Leader vs Detailer – What’s the Difference?

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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, lets say you are one of two subspecialists at NH 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.