Internal Medicine Leads the Way RADM Colin Chinn Command Surgeon, US PaCom RADM Brian Monahan The Attending Physician for US Congress and US Supreme Court CAPT Chris Culp Pacific Fleet Surgeon CAPT Mark Turner 5 th Fleet surgeon RDML Brian Pecha Medical officer of Marine Corps CAPT John Sanders CO, Naval Medical Research Center
CAPT Kyle Petersen CO, NAMRU-6 Lima CAPT John Gilstad CO, NAMRU 3-Cairo CAPT Jeff Timby Deputy Medical Officer of USMC FMF Specialty Leader EXECUTIVE OFFICERS: CAPT Michael McGinnisNH Guam CAPT Adam ArmstrongNAMRU-6 Lima CAPT Fred YeoNaval Submarine Medical Research Laboratory
Internal Medicine Leads the Way Who is your mentor? Whom are you mentoring? How should a mentor help you?
Medical Corps Manning TypeManningBillets Staff28642471 GME10091054 Total38733524 Overall manning is 110% of billeted end strength Increased retention – Normal attrition 10%/year – Currently 8%/year Source: Worldbook october 2013 Total MC billets in 2013: 3740 Total staff billets in 2013: 2706
Medical Corps Manning SpecialtyManning AEROSPACE MEDICINE63% ANESTHESIA136% AVIATION MEDICINE98% DERMATOLOGY109% DIAGNOSTIC RAD136% EMERGENCY MED119% FAMILY PRACTICE93% GENERAL MEDICINE106% INTERNAL MED 111% NEURO SURG120% NEUROLOGY96% NUCLEAR MEDICINE200% OB/GYN107%SpecialtyManning OCC MED102% OPHTHAMOLOGY111% ORTHOPEDIC SURG113% OTOLARYNGOLOGY113% PATHOLOGY98% PEDIATRICS111% PHYS MED & REHAB200% PREV MED100% PSYCHIATRY92% RADIATION ONC90% SURGERY88% UNDERSEA MED84% UROLOGY103% By Specialty
Internal Medicine by Specialty SpecialtyManningBillets % Manning General IM10069+17116 ID3431110 Pulm/CCM334672 GI2420120 Heme/Onc1312108 Endo98113 Nephro109111 Rheum75140 Allergy86133 Card3629124 Source: Worldbook Sep 2014
Is IM really overmanned? Probably close to being right sized The billet structure is not current with hospital needs – NH Camp Pendleton: 1 GIM billet, 5 IM staff – NH Beaufort: 1 GIM billet, 3 IM staff Several other Specialties have same issues
From the OOMC RADM Raquel Bono – Chief of the Medical Corps CAPT Mae Pouget – Deputy Chief of the MC October 21 FACEBOOK TOWNHALL meeting with RADM Bono – 21 October 1200-1300 – https://www.facebook.com/USNavymedicine https://www.facebook.com/USNavymedicine
From the OOMC No change in special pays – Static since 2010 HPSP has met recruiting goal (FY08-14)
From the OOMC MEDHOME – Empanelment targets 1100-1300
MedHome and the Neighborhood MGMA Standards based on 2012 report – 40% of nationwide average for each specialty Intentionally low to account for deployments, clinical inefficiencies
Conference Travel – Google “bumed travel policy” – “Mission critical” to attend conferences (board review ‘courses’ already approved) – ALL attendees MUST be named with conference submission package. – EACH ATTENDEE must be mission critical reason – Commands are referring to submitted lists
Professional Milestones LTLCDRCDRCAPT Learn specialtyPerfect specialtyTeach specialtyLeadership Residents and junior staff Majority board certified before CDR Board certificationLarge MTF Director Departmental collateral duty Major departmental committee Major command-wide involvement Executive Medicine tours (XO→CO) Operational: GMO, FS, UMO DIVO of small hospital Department Large MTF DH or Director, BHC OIC ECOMS chair, large MTF Hospital committee membership Credentials, P&T, Medical Records, Cardiac Arrest Chair of major hospital committee, ECOMS Chair Major operational tour: MEF, MARFOR Surgeon, DTMO, Fleet Surgeon, TYCOM Surgeon Operational: Regimental Surgeon, FS, UMO Operational: MLG, DIV, Wing Surgeon, CATF Surgeon, SMO Major BUMED, BUPERS, TMA, TRO tours BUMED, BUPERS tourSenior Clinician
MC Promotion Opportunity Medical Corps FY10FY11FY12FY13FY14FY 15 Opportunity 80% 60% Selects 6477905150 67 Opportunity 80% 70% Selects 145123100106145 111 Opportunity 100% 100%** 100% Selects 212275242318248 186 ** 88% in zone select rate
FY14 Promotions - LCDR Precept: 100% selection of IZ candidates 186 x 1.0 = 186 = max # of selects 4 (AZ) + 168 (IZ) + 14 (BZ) = 186 IM: 0 AZ 16/17 IZ; 1 BZ selected ZoneEligibleSelected% AZ13436 IZ18616890 BZ442143 FY14 O-4 Selection Results http://www.public.navy.mil/bupers-npc/boards/activedutyofficer/05staff/Documents/FY-14/FY14%20AO5S%20STATS.pdf
FY15 Promotions - CDR Precept: 70% selection of IZ candidates 159x 0.7 = 111 = max # of selects 78 (IZ) + 33(AZ) = 111 IM: 66% IZ (10/15) 8 AZ selected ZoneEligibleSelected% AZ923336 IZ1597849 BZ37300 FY15 O-5 Selection Results http://www.public.navy.mil/bupers-npc/boards/activedutyofficer/05staff/Documents/FY-15/FY-15%20AO5S%20CONVENING%20ORDER.pdf
FY15 Promotions - CAPT “Precept: 60% selection of IZ candidates” 112 x 0.6 = 67 max # of selects 53(IZ) + 14(AZ) = 67 IM: 11/14 IZ 1/10 AZ 0/36 BZ ZoneEligibleSelected% AZ1381410 IZ1125347 BZ20800 FY15 O-6 Selection Results http://www.public.navy.mil/bupers-npc/boards/activedutyofficer/06staff/Pages/default.aspx
PROMOTION BOARDS Google “BUPERS “ – “about BUPERS – us navy” “boards” “active duty staff officer “ “05 staff” Timing of sub-specialty training must be considered for O-5/O-6 Competitive FITREPs – Breaking out in COMPETETIVE peer group – “rightward progression” while in rank Increasing leadership role and positional responsibility! Ensure your photo is up to date, in current rank! Document Board Certification Manage your online Officer record, OSR/PSR Document accomplishments during FTOS training – Publications, Research Presentations Class rankings
From the OOMC MilSuite – One place to organize key data to answer frequent questions or find points of contact – Reduce reliance on email – More communication between the hospitals – We shouldn’t have to recreate the wheel
2014 Change…2015 uncertainty Ebola is an evolving problem ISIS -- Syria, Iraq? How will transition in Afghanistan go? 2016 budget: what will it be, and how will it affect us? Another year into e MSM’s GMO Conversions ??
Unique Opportunities CAPT Matthew Lim – BUMED liaison, Global affairs,DHHS LCDR Jamie Peterson – BUMED Medical Student Recruiting/Admin Fellow CAPT Utz – Health attache to VietNam MBA program – Navy PG School distance learning program
Billets 2014 Priority will be given to Staff – Returning from OCONUS, arduous sea duty – Deployment – Rank GMESB is next milestone, results released Dec 2014 Board certification required for MEDCEN billets Residents will be slated in January Specialty leaders are working closely with BUPERS for best fit for each individual, Command and Navy
Deployments 262 (610) Navy Medicine personnel currently deployed: 262 (610) 52 (331) Pending deployment: 52 (331) 9 (9) Internists deployed: 9 (9) – At this time 2011, 15 deployed 4 Internists pending deployment: 4 Top Internists Deployed Days 1CAPT Tim Burgess1704 2CAPT Jim Radike1258 3CDR Brian Wells766 4CDR Yevsey Goldberg735 5LCDR Mark Zeller712 6CDR John Bassett638 7LCDR David Bailey712 8CAPT Walter Downs567 9CDR Michelle Perello525 10LCDR R Wilkerson496 11CDR Daniel Juba488 12LCDR Scott Liu487 13CAPT Kurt Henry471 Data source: EMPARTS 12 Oct 2014
Deployment 50 50 Internists with >300 days of deployment 99 99 Internists with zero days of deployment (includes trainees) Navy Medicine tracks deployed days via EMPARTS – Not a perfect database, requires manual data entry – Ensure your deployments are correctly reflected in the system Data source: EMPARTS 12 Oct 2014
Deployment IM has/had habitual relationships for specific IAs – Pacific Partnership – Continuing Promise – EMF Kandahar (pulm/cc) – JTF GTMO (NE-2213) – EMF Djibouti (NE-2089) – Embedded Training Teams (NE-4255) – Forward Surgical Teams (NE-5326, NE-5254 )
Deployment Forecast FY15 Discussion with POMIs, nothing imminent Any Surprises in Afghanistan next spring? Syria, ISIS, Ebola…. Fiscal Climate affecting Humanitarian Missions Our Primary Role Is to Support These Deployments. We all must be ready….
Deployments For IM, what does it mean to be “operationally ready” (currency)? How do we measure that? What type of training would that require? What impact would that have?
IM Deployment Business Rules 1.No position is too important to deploy (except CO). 2.No one shall be recommended for deployment until everyone has deployed a first time. 3.Total deployed days taken in to account for deployment recommendation 4.In order to facilitate consolidation of knowledge and board passage, recently graduated fellows should be protected from deployment during their first post-GME year. 5.Prior overseas PCS moves will not count towards IAs. 6.Deployer order may be modified based upon extenuating circumstances and the needs of the Navy (i.e. a specific specialty is required or a particular institution is already heavily deployed). 7.Volunteers will always be solicited prior to assigning deployers. 8.Volunteering for one assignment, does NOT move you higher on the list for the next available assignment. 9.Chain of Command (and subspecialty SL if applicable) will be engaged prior to SL recommendation. 10. Will avoid by name requests, if possible, to sourcing MTF.
THANK YOU! Thank you for your professionalism Thank you for your hard work and dedication to our patients Thank you for constantly striving to improve Navy Medicine
Points of Contact CDR Daniel Seidensticker IM Specialty Leader Daniel.email@example.com CDR Joel Schofer Detailer Joel.Schofer@navy.mil CAPT Harry Ward Reserve IM SL Harryj.firstname.lastname@example.org
Also note, for a general internist each paRVU is worth $46.35 a Navy general internist to generate $88,899 in equivalent production. 2012 MGMA report (below), Navy MGMA 40% targets (right)
Promotion Guidance Timing of sub-specialty training must be considered if coming in to zone for O-5/O-6 Ensure your photo is up to date, in current rank! Manage your online Officer record, OSR/PSR Document accomplishments during FTOS training – Publications, Research Presentations Class rankings Professional Guidance
From the OOMC FITREPs are written for Promotion Board members Expectations – All MC Officers will complete residency – All MC Officers will achieve board certification O-6 board looks for demonstrated leadership – Clinical – Academic – Operational – Executive Pass PRT/BCA Professional Guidance
Change is coming to Navy Medicine Enhanced Multiservice Markets (eMSM’s) – PUGET Sound, Hampton Roads – National Capital Region – San Antonio, National Capital, Colorado Springs, Pearl Harbor – NMCSD, Camp Lejeune considered their own mini markets – CO of that eMSM will have operational control of all facilities