I recently gave a talk to the Emergency Medicine residents at NMC Portsmouth about authorship and academic careers in the Navy. Here is the outline of the talk and some tips…
Academic Career Options
There are a number of options for those who are interested in establishing an academic career in Navy Medicine. Here are the ones I know of:
- Residency programs at a medical center – Serving as teaching faculty at a residency program at Walter Reed, San Diego, or Portsmouth.
- Family Medicine (FM) teaching hospitals – Serving as faculty at the FM residency programs in Ft. Belvoir, Lejeune, Camp Pendleton, and Jacksonville. This opportunity is not just for FM physicians, but for Internists, Pediatricians, subspecialists, etc. as the FM programs need all of those people to support the education of their residents.
- Japanese internships – Both Yokosuka and Okinawa have internships that are structured like Transitional Internships and allow Japanese physicians to learn how American medicine is conducted. Most graduates try to obtain letters of recommendation and apply for graduate medical education (GME) in the US. Taking a leadership role in these programs can prepare you to lead GME programs when you PCS back to the US.
- Transitional internship programs – Leadership opportunities in Transitional Internships are open to just about every specialty, and many physicians have used Transitional Internship Program Director as the stepping stone to O6.
- Uniformed Services University of the Health Sciences (USUHS) billets – Many specialties have billets at USUHS that allow you to take a leadership role in the departments and teach medical students.
The opportunities to publish have increased dramatically during my 18.5 year career. For example, you’re reading this blog and that didn’t exist when I started. Here are the opportunities to publish that currently exist with some tips listed after each:
- Apps – This is the only thing on this list I haven’t tried, but there are articles that explain how to do it and tell stories of physicians who made money doing it.
- Blogs – This isn’t hard to do, so there’s nothing but time and effort preventing you from putting your opinion out there for others to read. Don’t underestimate how much time this takes, though, so know what you are getting into. I have literally spent thousands of hours on this blog.
- Books and book chapters – I’ve published 4 books (you can see 3 of them on Amazon here) by working with my specialty society, so that is one opportunity to pursue when it comes to books. The easiest way to start writing books chapters is to find someone you know that is senior to you who already writes chapters and offer to be a co-author for the next edition. If you go to your department head/chair or residency director, they should be able to tell you who writes book chapters in the department.
- Case reports – This is the entry path to publishing and where I made most of my initial academic bones. Frankly, publishing case reports gotten me a lot of my academic reputation, fitrep impact in block 41, and subsequent promotion to O4 and O5. Nowadays, there are a lot of journals and it is easier than ever to get something accepted, especially if you are open to publishing cases on blogs or in newsletters.
- Humanities – Many journals regularly publish 1-2 page articles about the experience of being a physician, ethics, military medicine, and other related topics. A common way to get one of these published would be to deploy and then write a humanities piece while deployed or upon returning about your experience.
- Newsletters – I wrote a personal finance column in one of our specialty society newsletters for 7 years. If you can get a regular gig like this, it will force you to write on a regular basis and really build your CV and academic reputation. Every specialty has newsletters and “throw away” journals that arrive in the mail. Contact the editors, offer to write something, and see if this is something you enjoy.
- Podcasts – Similar to blogs, this is fairly easy to do with some free software (Audacity), a $50 USB microphone headset, a podcast host (I host on this blog’s WordPress site but here are other hosts out there), and the time to figure out how to post your content on the Apple store. Like blogging, it is very time consuming. Personally, it is not my favorite thing to do (which is why my podcast has lagged way behind) because I have zero interest in learning how to properly edit recordings, but there is nothing preventing you from getting your voice out there.
- Research manuscripts – If you want to do research, you should start with the Institutional Review Board (IRB) that your command is subject to. There will be resources available to help you, but in my experience it is a pull system (you have to inquire and go get them) and they are not pushed to you. Typically, you’ll find grant writers, statisticians, and sources of money to do research. You’ll also find additional military rules and regulations heaped on top of all of the already existing IRB rules and regulations. This latter fact is what dissuaded me from doing a lot of research in my academic career.
- Review articles – Most journals solicit authors to write review articles, so it is hard to get one accepted if it is unsolicited. That said, if you shorten it a bit by focusing on a more narrow topic and build it around a case presentation, you can get them accepted as case reports.
How to Build Your Academic Career in the Navy
What is the easiest way to build an academic career? It is simple but not easy. Not that many people follow through on it. Here are the steps:
- Obtain a USUHS faculty appointment – This blog post tells you how to do it.
- Progress toward promotion
This 2nd step is the step that most people fail to follow through on. They get appointed as an Assistant Professor, and then they stop working toward promotion to Associate Professor or full Professor.
In general, an Assistant Professor is a local/regional expert, an Associate Professor has established themself as a regional/national expert, and a full Professor has reached national or international acclaim. If you touch base with your USUHS department once a year and get their assessment about what steps you need to take to get promoted, you will be forcing yourself to progress in your academic career.
For example, I’m an Associate Professor of Military & Emergency Medicine and recently applied to be a full Professor. The feedback I was given was that I needed 3-4 more peer-reviewed publications as the first author. I may or may not choose to try and get them, but at least they gave me an honest assessment of what I needed to do. If you do this annually, you’ll get actionable feedback that you can address as you build your academic chops.
Navy Medicine Professional Development Center (NMPDC) in Bethesda will be hosting facilitators from the Navy Leadership and Ethics Center (NLEC) for the instructing of two separate leader development courses in the coming months. Courses are as follows:
- Intermediate Leadership Course (ILC)
- 3-7 February 2020
- O4s (to include O4 selects)
- Senior Leadership Course (SLC)
- 6-10 April 2020
- O5s (to include O5 selects)
These are great opportunities for Navy Medicine officers local to the DC area to attend leader development courses while being offered locally. Currently these classes are only being offered to local attendees.
The point of contact for registering for the courses is LT Ryan Rigby (contact is in the global).
If you want to read how to get into these courses, you can read about them in this document.
(With GME results recently released, I figured this was as good a time as any to re-release this so that people who didn’t get selected for the GME they wanted could use this to strategize for next year. Enjoy!)
The Graduate Medical Education Selection Board (GMESB) results were released last week month with a 10 JAN deadline to accept or decline any spots you were offered. Undoubtedly there were some people who didn’t get what they want. I’ve participated in the last five GMESBs and would like to offer tips for people looking to match for GME in the future. We’ll cover general tips and those specific for internship and residency/fellowship:
- You can increase your score at the GMESB by having publications. If you want to give yourself the best chance of maximizing your score, you need multiple peer-reviewed publications. Any publications or scholarly activity have the chance to get you points, but having multiple peer-reviewed publications is the goal you should be trying to reach.
- Be realistic about your chances of matching. If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty. There are some specialties where you can overcome a major blight on your record, but there are some where you can’t. If this is applicable to you, the residency director or specialty leader should be able to give you some idea of your chances. Will they be honest and direct with you? I’m not sure, but it can’t hurt to ask.
- If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian. By the time you pay back your commitment to the Navy, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student. You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles.
Tips for Medical Students Applying for Internship
- Do everything you can to do a rotation with the GME program you want to match at. You want them to know who you are.
- When you are applying for internship, make sure your 2nd choice is not a popular internship (Emergency Medicine, Orthopedics, etc.). If you don’t match in your 1st choice and your 2nd choice is a popular internship, then it will likely have filled during the initial match. This means you get put in the “intern scramble” and you’ll likely wind up in an internship you didn’t even list on your application.
- Your backup plan if you don’t match should be an alternative program at the same site where you eventually want to match for residency. For example, in my specialty (Emergency Medicine or EM) we only have residencies at NMCP and NMCSD. If someone doesn’t match for an EM internship at NMCP or NMCSD, they will have a better chance of eventually matching for EM residency if they do an internship locally, like a transitional internship. Internships at Walter Reed or any other hospital without an EM program are quality programs, but it is much easier to pledge the fraternity if you are physically present and can get to know people, attending conferences and journal clubs when you can.
- You need to think about what you will do in your worst-case scenario, a 1-year civilian deferment for internship. Many of the medical students I interviewed did not have a plan if they got a 1-year deferment. I think every medical student needs to do one of two things. Either they should pick 10-15 civilian transitional year internships (or whatever internship they want) and apply to those just in case they get a 1-year deferment, or they should just plan to apply to internships late or scramble if this unlikely event happens to you. Most medical students do not grasp the concept that this could happen to them and have no plan to deal with it if it does. It is an unlikely event, especially if you are a strong applicant, and you can always just scramble at the last minute, but this is an issue that every medical student should think through. If you are going to just scramble at the last minute, that is fine, but it should be an informed choice.
Tips for Officers Applying for Residency or Fellowship
- You should show up whenever you can for conferences and journal clubs. Again, you want them to know who you are and by attending these events when you can you demonstrate your commitment to the specialty and their program.
- Always get a warfare device (if one is available) during your FS, UMO, or GMO tour. Not having it is a red flag.
Here is the newsletter:
The newsletter contains info on getting a faculty appointment, but here is an explanation recently sent out at NMC Portsmouth:
For those who help train USUHS students (medical students, NP trainees,
nurse anesthesia students, etc.), did you know that you are eligible for a
faculty appointment at USUHS? Why obtain a faculty appointment? If you
have an interest in academic medicine, a faculty appointment is an important
part of your CV. If you are going to make a career in academic medicine,
the longer you hold a faculty appointment, the better your chances for
faculty promotion. Outside the military, promotion equates to more salary
and is sometimes necessary to be considered for certain academic positions.
So how do you get one? First, you need to determine what academic “rank”
you are eligible for. See the Clinicians Flow Chart attachment, but for
most the deciding factor will be if you have routine versus random/episodic
teaching of USUHS students. Clinicians who regularly teach USUHS students
generally will qualify to become a Clinical Assistant Professor. Those with
intermittent, random or episodic teaching can be appointed an Adjunct
Instructor or Adjunct Assistant Professor.
To apply, you will need to gather the appropriate documents per the
appointment promotion checklist attachment. For example, to become a
Clinical Assistant Professor you will need:
– to complete the Online Faculty Appointment Application
– a CV in AAMC Format
– a letter of recommendation from the local department chair or
– a command endorsement (this is usually brief, at the end of the
above letter of recommendation)
– complete a USU Form 107
This information is then forwarded to the appropriate USUHS Department POC
(see the dept POCs attachment) who then presents this for appointment to the
University. Subspecialists fall under the parent specialty (for example,
Ophthalmology would go to Surgery). More information is available at:
The memorandum to the Surgeons General requests the widest dissemination of the announcement to ensure that all physicians desiring an assignment as a Program Director have the opportunity to apply.
Here also is the DoD Policy and Selection Criteria for GME Program Directors, as well as the ACGME requirements for this position.
Please note: Applicants are required to submit a bio in addition to CV and letter of intent, NLT 1 Nov 2019, to CDR Melissa Austin (contact in the global). Applications should have concurrence from their Detailer and Specialty Leader.
An applicant’s CV must include a section about faculty development activities that they have done.
An applicant’s CV must demonstrate at least 3 years of documented education and/or administrative experience, as well as ongoing clinical activity in the (sub)specialty for which they are applying.
An applicant’s CV must demonstrate current board certification in the (sub)specialty in which they are applying. Current medical licensure must also be documented on the CV.
An applicant’s CV must demonstrate current ongoing scholarly activity.
The Letter of intent must include the candidate’s level of commitment to GME and the Program Director position, including the number of years they are willing to serve, and that if selected, that they will accept the position. This program is 6 years in length.