I’ve been asked this question multiple times since the FY21 LCDR promotion board stats came out. Many looking at the stats noticed these facts:
- The overall in-zone promotion rate was 83.19%.
- The rate for GMOs, UMOs, and Flight Surgeons were all lower than this:
- GMO – 66.67%
- UMO – 40%
- Flight Surgery – 42.86%
This seems to argue against the recent advice to “go operational” to successfully compete for promotion. What gives? The following is my best guess, and it is a guess. I was not on the board, and if I was I wouldn’t be able to talk about it.
Let’s look at the typical career path for a Medical Corps LT who does GMO, UMO, or Flight Surgery:
- Year 0 – Graduate from medical school and put on LT.
- Year 1 – Finish internship and go GMO, UMO, or Flight Surgery.
- Years 2-4 – Do a 2-3 year operational tour.
- Years 3-4 – Match in a residency program.
- Year 5 – You are in-zone for LCDR.
If in year 5 you are still a GMO, UMO, or Flight Surgeon, you probably haven’t matched in a residency either because you can’t or you’ve chosen to pay back the 3-4 years you owe the Navy and get out. In the latter case, you may have approved resignation orders in the system, which the promotion board will see on your record.
This timeline is obviously not applicable to anyone with prior service, entry-grade credit, or an abnormal promotion timeline, but it is applicable to the majority of Medical Corps LTs. For example, I did internship, 1 year as a GMO, 3 years of residency, and then was picked on-time/in-zone for LCDR, which I put on as a staff Emergency Physician. Back in the day, I showed up in the stats under Emergency Medicine. Anyone in a residency will show up under their specialty’s statistics.
Bottom Line – Why didn’t more GMOs, UMOs, and Flight Surgeons promote to LCDR?
Again, this is just a guess, but if you are in an operational billet your 5th year you either can’t match in a residency or are getting out, both of which do not portend well for promotion.
Takeaway – Your primary job and career goal as a LT is to match in a residency program that will lead to board certification. You can always “go operational” later. Spending too much time in the operational setting can lead to difficulties promoting.
Please see the announcement below from the Flight Surgery Specialty Leader:
I know a few of you have already talked to me or have asked about both the Program Director for the Aerospace Medicine Residency as well as the NAMI Academics Director for the flight surgeon program. The PD billet typically come with an extended set of orders, although they may be only written for 3 years, 5-6 years is not atypical. The Academics Director job is typically a 3-4 year billet. I lay this out so you know what you are getting yourselves into and understand this is not a 2 years and then retire plan. There is a small number of you that are eligible for these positions and this e-mail is directed at you, but I will be sending the announcement to the Corps Chief’s Office as well. There may be some interest outside of AMS for the Academics Director position, but that individual will need to have been active in flight surgery recently. The PD job obviously requires you to be board certified is Aerospace Medicine, so if you are not currently BC, then you need to sit for your boards in OCT and pass them. Research, leadership positions and the breadth of your experience will also factor into your application.
The application will include your biography, CV and a separate personal statement for each position. For each position, address you’re your motivation to assume that job and what your vision for the program is over a 5 and 10 year period. I know you will not be there for 10 years, but what do you want the program to look like in the future. How will increased UAV usage effect training? What about the gradual conversion of “GMO/OMO”’s to board certified physicians. How would that impact Flight Surgery Training? How would straight through training effect the RAM and what would that internship look like? These are some real questions that may need to be addressed during your time in the seat. Please keep this to 1-2 pages.
We will have a board to review the applications who will then select the next PD and Academics Director. The board will consist of the NAMI OIC, the incumbent, myself .and former TYCOM surgeons.
I know everyone is under different stresses, depending on their current billet, but please send me you applicant packages NLT 18 September. The intent is to have a decision made by October, so turnover plans can begin and the incoming PD and Academics Director can participate in resident selection as well as flight surgeon selection.
Please note this date is different than what I have on the announcement, since I did not get this out yesterday as expected.
Robert J. “Biff” Krause, MD, MPH, CIME
CDR, MC (AMS), USN
Aerosapce Medicine Analyst
Naval Safety Center (Code 14A)
Specialty Leader, Aerospace Medicine and Flight Surgery
Please see the message below that better aligns the application timeline for Undersea Medicine and Flight Surgery due to the COVID-altered GME timeline. Summary…Flight and Dive applicants will find out if they were selected the same date as they will for GME (6 JAN 2021) and have 2 weeks to accept/decline on the same day they do that for GME (20 JAN 2021).
MSGID/GENADMIN/SECNAV WASHINGTON DC/-/MAR//
SUBJ:/MODIFY BUMEDINST 1520.42A TO ALIGN WITH UNDERSEA MEDICINE AND AEROSPACE MEDICINE OFFICER CANDIDATE APPLICATION DUE DATES IN BUMEDNOTE 1524//
REF/A/DOC/ BUMEDINST 1520.42A/BUMED/31JUL19//
REF/B/DOC/ BUMEDNOTE 1524/BUMED/31JUL20//
NARR/REF A IS THE APPLICATION GUIDANCE FOR UNDERSEA MEDICAL OFFICER AND AEROSPACE MEDICINE PROFESSIONAL TRAINING. REF B IS THE 2020 JOINT SERVICE GRADUATE MEDICAL EDUCATION SELECTION BOARD APPLICATION PROCEDURES OUTLINING THE COVID-19 UPDATED CANDIDATE APPLICATION DUE DATES. REF A MUST BE MODIFIED TO ALIGN WITH REF B.//
RMKS/1. This ALNAV announces a modification to BUMEDINST 1520.42A to align with BUMEDNOTE 1524, which describes the COVID-19 altered timeline for Graduate Medical Education Application. Undersea Medicine (UM) and Aerospace Medicine (AM) Officer candidate application due dates are now the same as set-forth in the BUMEDNOTE 1524. Specifically, the updated deadline for acceptance/declination is 20 JAN 2021.
2. Mission. Align deadlines for Navy graduate medical education selection program, Undersea Medical Officer and Aerospace Medical Officer programs.
3. Policy. This ALNAV applies to all uniformed military Navy and Marine Corps personnel submitting an UM or AM Officer Candidate application during the remainder of Fiscal Year 2020 and Fiscal Year 2021.
4. Point of Contact. Please direct all questions to CAPT Joel Schofer, Deputy Chief, Medical Corps / UM Specialty Leader, email@example.com, (703) 681-8917; CAPT Mucciarone, UM Specialty Leader, firstname.lastname@example.org, (808) 473-5789; or CDR Robert Krause, AM Specialty Leader, email@example.com, (757) 444-3520.
5. Released by RADM Bruce L. Gillingham, Surgeon General, U.S. Navy.
The missing piece in people’s records, and an increased focus in Navy Medicine, is often operational experience. Residency trained physicians DO NOT need to apply through the GME Selection Board to join the ranks of Flight Surgery or Undersea Medicine. Here are messages from those Specialty Leaders that tell people how to inquire about opportunities…
The Undersea Medical Community has over 100 billets. Approximately 1/3 of the billets turnover every year. In addition to the billets for Lieutenants, there are many opportunities for Lieutenant Commanders, Commanders and Captains. There are billets with operational units, at research commands, and in BSO-18 facilities; CONUS and overseas.
If you are interested in an experience that is truly unique to Navy Medicine, please contact the Undersea Medicine
James J. Mucciarone, MD, CPE
CAPT, MC, USN
Undersea Medicine Specialty Leader
james dot mucciarone < at > navy dot mil
For those individuals with previous experience as a Flight Surgeon, there are opportunities to return to the Fleet in an operational capacity. Job opportunities for senior officer’s with the USMC as a MAG Surgeon will be available and unaccompanied overseas tours typically come up yearly. Positions as a SMO on an aircraft carrier are possible on a case by case basis for non-Aerospace trained physicians who meet requirements
For those who have not been a Flight Surgeon, the training program is still open to those who physically qualify. Flight Surgery training in Pensacola for 6 months would be followed by a Fleet tour with the USMC or Navy. More information can be found on the NMOTC Website:
Please contact me if you have any questions.
CDR Robert J. Krause, MD, MPH, CIME
Specialty Leader – Aerospace Medicine and Flight Surgery
SMO < at > CVN74 dot navy dot mil
By Dr. Keith Roxo, LCDR, MC(FS), USN*
I teach the medical logistics lecture for the flight surgery course at NAMI. I don’t do it because I love logistics or am some kind of logistical guru; I do it because it is a great way to have a discussion about mindset for young physicians.
I begin the lecture by asking if there are any medical students in the class. It seems silly, right? They smile and look around thinking that I am being silly. Next I ask how many interns or residents are in the class. I raise my own hand because I am a resident in the Aerospace Medicine program, but generally I’m the only one with my hand up. They are starting to get a little confused by my line of questioning. It is all set up for my next question: “if you aren’t a medical student, intern, or resident then what are you?”
The answer is that they are an attending physician. And after telling them that they are all, indeed, attending physicians, I get a lot of wide eyes in the crowd. The occasional student, who happens to already be board certified before going into flight surgery, already understands this, but they are few and far between.
For the last five years most of the flight surgery students have had near constant supervision and have not had the final say on any patient. Every plan or prescription had to be run through someone else before being executed. They have very little experience doing it on their own, but many are about to be thrust into that position. They need to start thinking about how they want to run their practice, solidifying resources and contacts, how do they get help for more challenging cases, how to handle a mishap, and how to transfer a patient from an austere location. Better to start thinking about this stuff from the safety of the Pensacola beaches or classroom rather than when a problem first develops.
Meanwhile, the logistics part of the talk is a way for me to get them to also think of themselves as a mini-department head. It doesn’t matter if your Marine Air Group (MAG) surgeon or the military treatment facility is supposed to manage your supplies, if you go on det or deployment missing items, it hurts you and your people. Better to be involved in your supply than to trust the system blindly.
Not all GMO positions are equal. Some are on a staff with other senior physicians. However, some are running solo with a squadron, infantry unit, etc. without much support from more experienced physicians. Getting your mindset right before you are in those positions can go a long way to better preparedness.
*The views expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the United States Government.