Why Didn’t More GMOs, UMOs, and Flight Surgeons Promote to O4?

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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.

Guest Post – Mindset for the GMO, UMO, and Flight Surgeon

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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.

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.***



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