detailing

Throwback Thursday Classic Post: 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, 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.

Throwback Thursday Classic Post – How to Manage Your PRD and Not Get Stuck with a Hotfill

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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:

https://www.bol.navy.mil/

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:

https://www.public.navy.mil/bupers-npc/officer/Detailing/rlstaffcorps/medical/Pages/default.aspx

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.

Throwback Thursday Classic Post – How to Manage Your PRD and Not Get Stuck with a “Hotfill”

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(I’m going to start re-posting some of the better and more popular blog posts on the site on Throwback Thursday. Much of the content is evergreen or requires minimal updates, and the blog has a much larger readership than when many of these posts first ran.)

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.

Know 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:

https://www.bol.navy.mil/

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.

Manage Your PRD

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 “expire” 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.

Powerpoints from Last Week’s Specialty Leader Business Meeting

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Last week was the Specialty Leader Business Meeting, which is always held in conjunction with the GME Selection Board. If you want to see the following Powerpoint decks, they are available on the Medical Corps Sharepoint Site (pick your e-mail CAC certificate or it won’t open for you):

  • DHA Organizational Update
  • Finding Joy in Work
  • GME Interdependency Brief
  • GME Overview
  • Military Unique Curriculum
  • PERS Pearls

I would post them, but the one about DHA is labelled “for internal use only” and there are too many authors of the other ones to get permission to post them on the blog. Because of all the change going on, I wanted to call attention to their availability.

Latest Guidance on Extension Requests from the MC Detailers

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Here is the latest update we were sent on extension requests:

As always, the MILPERSMAN is our guidance for billet assignments. Here is our current interpretation of the MILPERSMAN regarding extensions:

Extensions will be considered on a case-by-case basis when the following conditions have been met in the specialty:

  1. Operational billets are all filled
  2. OCONUS/remote duty stations are filled with appropriate medical officers (can’t all be new-residency graduates)
  3. All CONUS billets are filled (no gaps)
  4. Desirable billets have been considered for members coming from undesirable commands
  5. Egregious Time On Stations will be viewed critically

Multiyear extensions will be considered in the minority of cases. Scenarios where they may be considered include:

  1. Two-year extensions for newly named directors or department heads for large departments
  2. Program directors per ACGME requirements
  3. Co-locations for the above two
  4. Small communities where no one wants to move
  5. Statutory retirement in 2 years

If you have any questions, contact your Detailer.

2018 GMO Billets Available Starting 11 SEP 2017

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Please see this note from the GME Detailer. Of note, I don’t have the list of available billets (but probably wouldn’t post it for OPSEC reasons even if I had it). I’d contact her if you need it (her contact info can be found here):

1. This notice is for ALL PGY1’s who intend to request GMO tours (do not have active applications submitted for GMESB consideration). If you have an active application in MODS, there is no need for you to take any action; merely wait for the GMESB to publish selection results in December…best of luck to each of you!

If you DID NOT apply, please pay attention to the steps below:

2. In order to secure PCS funding/estimate PCS budget, I am going to enter negotiations with PGY1’s (desiring GMO tours) earlier than normal.

  • Monday, 11 SEP 2017 starting at 0700 CDT you may call in to discuss available GMO billets ***again, this call-in time is ONLY for those people who DO NOT have a MODS application/are not requesting consideration for GME ***

3. Please review the attached list of downstream billets. Have at least 3 choices selected from this list prior to calling/contacting me (preferably not all in the same area/type billet). Do not request a billet you are not eligible for (for example, do not select a billet marked “2nd tour GMO”), it creates frustration for both of us!

4. If you have co-location or EFM concerns, please ensure your status is current/updated prior to negotiating orders; otherwise I will be unable to complete the detailing process with you. If you are unsure of your status, feel free to contact me.

*** This slight departure from previous PGY1 detailing will hopefully provide official orders in a more timely manner and also load balance the detailing phone calls. There will always be billets for people, so no one should be stressed about having a “home”. It is not mandatory to call on the 11th of September to request orders, but that will be the first available opportunity for PGY1’s to select follow-on GMO duty station assignments.***

V/r,

LCDR G

Kayreen K. Gucciardo
LCDR, MSC, USN
Medical Corps Assignments (PERS-4415R)
GME Placement / GMO Detailer

Detailing Marketplace: Using Economic Principles to Improve Detailing

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by Richard Childers, MD, Will Beasley PhD, and Joel Schofer, MD, MBA, CPE

The Navy recognizes the need to improve the detailing process and has explored a number of efforts to modernize assignment practices.  An example is the Detailing Marketplace (DM) Pilot Project that was used to assign the 2017 Emergency Medicine billets.  The DM optimized billet assignments by leveraging the best practices of market design economics.

In a traditional marketplace, money is a tool that facilitates transactions.  Buyers can review products, consider their cost, and then purchase a desired product.  Once the buyer chooses an item, a transaction can proceed.

In contrast, a Matching Marketplace (MM) requires two sides to select each other.  Examples include medical students matching to residencies, law students matching to judicial clerkships, and high school graduates matching to colleges.  For officer assignments, the Navy has a potential MM in which commands and officers select each other.  We say “potential” because some commands may have input into assignments, but many do not.

Market Design is the field of economics that focuses on optimizing these markets.  One prominent economist, Al Roth—Professor of Economics at Stanford—won the 2012 Nobel Prize in Economics for his work in this field.  One of his most notable achievements was designing the National Residency Match Program that matches civilian physicians to their residency training positions.  In his book, Who Gets What and Why, he describes the three components to an ideal MM:  they should be (a) thick, (b) safe, and (c) uncongested.

Thickness

A thick market has lots of buyers and sellers; the more options a buyer has to choose from, the more likely they will find something suitable to their unique taste.  This principle is easy to understand; would you rather see all the billets available to Medical Corps officers or just the top three the detailer thinks are appropriate for you?

One reason the Navy is structured towards a thin market is our general tendency for rolling admissions to the marketplace.  As individuals approach their Projected Rotation Date (PRD), negotiations commence.  Individuals tend not to see the range of billets available, just the ones near their PRD.

A second important reason why officers are not presented an abundance of billet options is due to the cumbersome nature of the mechanics of detailing.  The process of advertising billets involves pulling data from our detailing software, translating that data to an Excel file, and then emailing that to members or Specialty Leaders.  Each one of these steps is cumbersome and provides an opportunity for error. It is also time-intensive, which makes it less likely the detailer will maintain an accurate product.

To create a thick market in our pilot project, we forced every possible officer with a PRD in FY17 who wanted an Emergency Medicine billet into the match.  From the 58 Emergency Physicians who were eligible for orders in 2017, 12 were issued orders outside the match, resulting in a 79% participation rate.  Reasons for exclusion included: sub-specialty training and assignment, co-location, non-Emergency Medicine operational billets, promotion, extensions for retirement, and pending administrative issues.

In July 2016, 46 billets (35% operational and 20% OCONUS) were posted for the 46 participating officers to consider.  Commands were provided contact information for all 46 officers so they could initiate recruitment efforts if they desired.  Parties were given several months to interact in whatever manner they determined appropriate; typically this involved officers sending their CV and arranging an interview with the command’s Department Head.  In January 2017, commands and members independently submitted rank lists that were entered into the matching algorithm.

Safe

The best MMs are safe.  A safe marketplace is one in which the buyers and sellers can act in their own self-interest without negative consequences; where desires can be freely expressed without a need to strategize the system.  Unsafe MMs come up frequently in systems that emphasize the importance of giving buyers their “first pick” which might, at first glance, be a reasonable metric to measure the success of a marketplace.

The problem with this metric is that it forces participants to approach the system differently because officers who do not get their first pick have a decreased probability of getting their second pick.  Consider an officer who really wants Naval Medical Center San Diego (NMCSD), a highly sought after location, but would be happy at Naval Hospital Camp Pendleton (NHCP) which is less competitive.  Now imagine the detailer wants to give the officer their first choice.  In this scenario, the officer has an incentive to tell the detailer that NHCP is their first choice to ensure she at least gets her second pick, even though she would have preferred a tour at NMCSD. This is because in a system that prioritizes giving people their first choice, the detailer is more likely to provide a less competitive officer NHCP if it is listed as their first choice.  An ideal system would allow the officer to list her true preferences without diminishing her chances at other commands.  In the example above, our officer should be able to list NMCSD first, without diminishing her chances of matching at NHCP if listed second.

A key to a safe matching marketplace is the use of the deferred acceptance algorithm (DAA).  This is the algorithm economists have used to maximize outcomes in various matching marketplaces, including the National Residency Match Program.  (For a brief demonstration, we recommend watching this video.)  Put simply, this algorithm allows participants to rank their true desires and not have the order in which those desires are placed affect the final outcome.  In the example above, not matching at one’s top pick does not diminish the chances of getting selected for their second pick.  It allows participants to simply rank their choices without having to strategize how the system works.  We used the DAA to assign Emergency Physicians their billet in our pilot project.

Another risk to safety is loss of anonymity.  Commands want officers who are motivated to join their staff; thus, if commands can see officer rank lists, it is likely to influence their rankings.  In our pilot, we kept the rank lists anonymous.  Commands ranked their top picks without knowing the officer’s desires; similarly, officers submitted their rank lists anonymously.

Uncongested

A thick market is important to have, but it can lead to congestion.  An uncongested market allows enough time for market participants to make satisfactory choices when faced with a variety of alternatives. Other than our system to assign Graduate Medical Education and Executive Medicine billets, the Medical Corps does not have a good central clearinghouse for job assignments.  The Detailer and Specialty Leader assign some billets, others are vetted by the Corps Chief’s office, and others are considered by individual commands.  Each of these steps is performed at an individual level and is time intensive; also, selection for one job is frequently done independently of another.  All of these factors contribute to marketplace “unraveling.”

Consider a scenario where an officer is considering two positions: a leadership position with the fleet in San Diego and a Global Health Engagement (GHE) billet in New Zealand.  While she would prefer the fleet job, she would gladly take the GHE billet.  She applies for both and is offered the GHE position but must commit within a week.  The fleet job will not be offered for three weeks, so she declines the GHE billet in the hopes of receiving the fleet billet.  Unfortunately, she is ultimately not offered the fleet billet in San Diego.  She then gives up in frustration and gets a flight surgeon position she did not really want.  This undesirable unraveling can be prevented if a central clearinghouse uses an algorithm that processes the specified preferences in a single match day.

Results of the Pilot Project

Project results, including a pre-and post-intervention survey, are still being reviewed; however, some preliminary lessons can be described.  We believe our overall goals were adequately addressed.  First, the market was relatively thick – all officers saw the available billets.  Second, the rules were transparent, and the participants knew the process for billet assignments.  Third, commands had the ability to recruit the members they needed to accomplish their mission.  Fourth, it is highly likely that this process led to the best net outcome.

Some participants expressed disappointment that they did not match with their top choice.  They felt that the point of a DM was to match everybody with their top choice, but that is not the goal of a marketplace.  The goal is to optimize outcomes.  As long as there is variation in the desirability of billets, some participants will not receive their top choice.

One drawback was the effort involved for market participants.  Most commands had not assisted in the selection process in the past, so efforts at recruiting and screening individuals was an unanticipated work requirement.  In a similar way, Medical Officers previously communicated their desires only informally; now they had to submit a CV and complete interviews.  However, the improvements obtained justify these additional efforts.  As the process becomes more streamlined in the future, additional work should be minimized.

The present algorithm is modeled after the one used for the National Residency Match Program.  While it worked for many of our assignments, there are important differences between the residency match and a military match.  In their system, anybody can go to any position.  This is not the case in the military; there are many officers who are constrained in their assignability by the Exceptional Family Member Program (EFMP) and by active-duty co-location requirements.  Also, in the residency match program, it is acceptable for training positions to go unfilled and for medical students to not match. For the military, billets must be filled and officers must be assigned a job.

There are other military specific adjustments we would like to include in our algorithm.  Of the eight billets that went unfilled in our match, all were OCONUS and many were operational.  This might be correctable in the future by incentivizing less desirable billets.  Also, a way to automate active-duty co-location and EFMP requirements would be beneficial.

Lastly, our process does not eliminate the potential for nepotism or talent concentration.  It prevents Detailers from favoring individuals, but does not prevent commands from doing this.  Ideally, nepotism at a local level would be more identifiable and correctable than nepotism at the Detailer level.  There was some regulation in our project to prevent nepotism and talent concentration.  For example, a command could only fill half their preferences from within their own command.  For example, If a command had four available billets, at most two could be filled with officers already at the command.

Conclusion

As the Navy modernizes our billet assignment process, we should leverage the economic principles of marketplace design.  Our pilot project, whose results we are still exploring, produced mixed results but is promising.  The framework of a matching marketplace can be successfully applied to officer detailing, and may be improved through adjustments specific to the military environment.