Presentation on theme: "Internal Medicine Specialty Leader Update Navy ACP 2014"— Presentation transcript:
1Internal Medicine Specialty Leader Update Navy ACP 2014 We are fortunate to have significant IM representation within Navy Medicine, including:SG Admiral NathanOOMC Admiral ChinOAP Admiral MonahanNH Bremerton CAPT CulpNH Yokosuka CAPT TurnerNHRC CAPT UtzDaniel Seidensticker, MD, FACP, FACCCDR, MC, USN
2Navy MedicineMissionWe enable readiness, wellness, and health care to Sailors, Marines, their families, and all others entrusted to us worldwide – be it on land or at seaWhere are we heading as a community? It’s important to know what the SG feels is important and to know his guiding principles.VisionNavy Medicine is the pinnacle of excellence – answering the call across any dynamic – from kinetic operations to global engagement. Our health care is patient-centered and provides best value, preserves health, and maintains readiness. Agility, professionalism, an ethos of care, and the ability to deploy to any environment or sea state are our hallmarks
4Internal Medicine Leads the Way RADM Colin ChinnCommand Surgeon, US PaComRADM Brian MonahanThe Attending Physician for US Congress and US Supreme CourtRDML Brian PechaMedical officer of Marine CorpsIn addition to the Surgeon General, we are fortunate to have significant IM representation within Navy Medicine, including:SG Admiral NathanPA COM surgeon Admiral ChinOAP Admiral MonahanPac Fleet CAPT Culp5th Fleet CAPT TurnerNMRC CAPT SandersCAPT Mark Turner5th Fleet surgeonCAPT John SandersCO, Naval Medical Research CenterCAPT Chris CulpPacific Fleet Surgeon
5Deputy Medical Officer of USMC CAPT Jeff TimbyDeputy Medical Officer of USMCFMF Specialty LeaderCAPT Kyle PetersenCO, NAMRU-6 LimaCAPT John GilstadCO, NAMRU 3-CairoEXECUTIVE OFFICERS:CAPT Michael McGinnis NH GuamCAPT Adam Armstrong NAMRU-6 LimaCAPT Fred Yeo Naval Submarine Medical Research Laboratory
6Internal Medicine Leads the Way Who is your mentor?Whom are you mentoring?How should a mentor help you?
7Source: Worldbook october 2013 Medical Corps ManningOverall manning is 110% of billeted end strengthIncreased retentionNormal attrition 10%/yearCurrently 8%/yearTypeManningBilletsStaff28642471GME10091054Total38733524Take-away messages:At any given time about 28% of our physicians are in GME, residency, Internship or fellowship. That percent has been constant since before 9?11 and continues to be constant today—no plans to downgrade GME—a vital element in viable Medical CorpsGS + Contract (21% of staff work force)GS/Contract physicians comprising greater % than ever, now about 13% of our workforce. Emphasizes concept of “One Navy Medicine” under which AD/Reserves/Civilians must all work together to accomplish missionTotal MC billets in 2013: 3740Total staff billets in 2013: 2706Source: Worldbook october 2013
8Medical Corps Manning INTERNAL MED 111% By Specialty Specialty Manning AEROSPACE MEDICINE63%ANESTHESIA136%AVIATION MEDICINE98%DERMATOLOGY109%DIAGNOSTIC RADEMERGENCY MED119%FAMILY PRACTICE93%GENERAL MEDICINE106%INTERNAL MED111%NEURO SURG120%NEUROLOGY96%NUCLEAR MEDICINE200%OB/GYN107%SpecialtyManningOCC MED102%OPHTHAMOLOGY111%ORTHOPEDIC SURG113%OTOLARYNGOLOGYPATHOLOGY98%PEDIATRICSPHYS MED & REHAB200%PREV MED100%PSYCHIATRY92%RADIATION ONC90%SURGERY88%UNDERSEA MED84%UROLOGY103%Data source: the “World Book”BUMED (M13)Sep 2014
9Internal Medicine by Specialty ManningBillets% ManningGeneral IM10069+17116ID3431110Pulm/CCM334672GI2420120Heme/Onc1312108Endo98113Nephro10111Rheum75140Allergy6133Card3629124Note, this data from sep 2014Overmanning not completely bad – allows flexibility for some internists to be utilized in other capacities (operational, leadership) to fill possible nontraditional roles within Navy Medicine.Source: Worldbook Sep 2014
10Is IM really overmanned? Probably close to being right sizedThe billet structure is not current with hospital needsNH Camp Pendleton: 1 GIM billet, 5 IM staffNH Beaufort: 1 GIM billet, 3 IM staffSeveral other Specialties have same issues
11From the OOMC RADM Raquel Bono CAPT Mae Pouget Chief of the Medical CorpsCAPT Mae PougetDeputy Chief of the MCOctober 21 FACEBOOK TOWNHALL meeting with RADM Bono21 Octoberhttps://www.facebook.com/USNavymedicineJoint credentials vetted by AF, Army and Navy specialty leaders. Attempted to balance differing service philosophies in the credentialing process as well as how internists/specialists are used by their respective service. Opportunity will continue to exist to refine credentials after implementation.
12From the OOMC No change in special pays Static since 2010HPSP has met recruiting goal (FY08-14)
14MedHome and the Neighborhood MGMA Standards based on 2012 report40% of nationwide average for each specialtyIntentionally low to account for deployments, clinical inefficiencies
15Conference 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 reasonCommands are referring to submitted lists
16Professional Milestones LTLCDRCDRCAPTLearn specialtyPerfect specialtyTeach specialtyLeadershipResidents and junior staffMajority board certified before CDRBoard certificationLarge MTF DirectorDepartmental collateral dutyMajor departmental committeeMajor command-wide involvementExecutive Medicine tours (XO→CO)Operational: GMO, FS, UMODIVO of small hospital DepartmentLarge MTF DH or Director, BHC OICECOMS chair, large MTFHospital committee membershipCredentials, P&T, Medical Records, Cardiac ArrestChair of major hospital committee,ECOMS ChairMajor operational tour: MEF, MARFOR Surgeon, DTMO, Fleet Surgeon, TYCOM SurgeonOperational: Regimental Surgeon, FS, UMOOperational: MLG, DIV, Wing Surgeon, CATF Surgeon, SMOMajor BUMED, BUPERS, TMA, TRO toursBUMED, BUPERS tourSenior Clinician
17MC Promotion Opportunity Medical CorpsFY10FY11FY12FY13FY14FY 15Opportunity80%60%Selects64779051506770%145123100106111100%100%**212275242318248186** 88% in zone select rate
18FY14 Promotions - LCDR Zone Eligible Selected % AZ 13 4 36 IZ 186 168 FY14 O-4 Selection ResultsZoneEligibleSelected%AZ13436IZ18616890BZ442143Precept: 100% selection of IZ candidates186 x = 186 = max # of selects4 (AZ) (IZ) (BZ) = 186IM: AZ 16/17 IZ; 1 BZ selected
19FY15 Promotions - CDR Zone Eligible Selected % AZ 92 33 36 IZ 159 78 FY15 O-5 Selection ResultsZoneEligibleSelected%AZ923336IZ1597849BZ373Precept: 70% selection of IZ candidates159x 0.7 = 111 = max # of selects78 (IZ) + 33(AZ) = 111IM: 66% IZ (10/15) AZ selected
20FY15 Promotions - CAPT AZ 138 14 10 IZ 112 53 47 BZ 208 FY15 O-6 Selection ResultsZoneEligibleSelected%AZ1381410IZ1125347BZ208“Precept: 60% selection of IZ candidates”112 x = max # of selects53(IZ) + 14(AZ) = 67IM: 11/14 IZ /10 AZ 0/36 BZ
21PROMOTION 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-6Competitive FITREPsBreaking out in COMPETETIVE peer group“rightward progression” while in rankIncreasing leadership role and positional responsibility!Ensure your photo is up to date, in current rank!Document Board CertificationManage your online Officer record, OSR/PSRDocument accomplishments during FTOS trainingPublications, Research Presentations Class rankings
22From the OOMCMilSuiteOne place to organize key data to answer frequent questions or find points of contactReduce reliance onMore communication between the hospitalsWe shouldn’t have to recreate the wheelhttps://www.milsuite.mil/book/community/spaces/navy-medicine/navy-medical-corps
232014 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’sGMO Conversions ??79% of 06 selects had competitve EP’s21% o6 selects were 1/196% board certified69% of 06 selectsit is consistently high performance in a variety of assignments with increasing leadership responsibilities.
24Unique Opportunities CAPT Matthew Lim LCDR Jamie Peterson CAPT Utz BUMED liaison, Global affairs,DHHSLCDR Jamie PetersonBUMED Medical Student Recruiting/Admin FellowCAPT UtzHealth attache to VietNamMBA programNavy PG School distance learning program
26Billets 2014 Priority will be given to Staff Returning from OCONUS, arduous sea dutyDeploymentRankGMESB is next milestone, results released Dec 2014Board certification required for MEDCEN billetsResidents will be slated in JanuarySpecialty leaders are working closely with BUPERS for best fit for each individual, Command and Navy
27Top Internists Deployed Days DeploymentsTop Internists Deployed Days1CAPT Tim Burgess17042CAPT Jim Radike12583CDR Brian Wells7664CDR Yevsey Goldberg7355LCDR Mark Zeller7126CDR John Bassett6387LCDR David Bailey8CAPT Walter Downs5679CDR Michelle Perello52510LCDR R Wilkerson49611CDR Daniel Juba48812LCDR Scott Liu48713CAPT Kurt Henry471Navy Medicine personnel currently deployed: 262 (610)Pending deployment: 52 (331)Internists deployed: 9 (9)At this time 2011, 15 deployedInternists pending deployment: 415 internists were deployed at this time last year.EMPARTS is not a perfect system. It’s your responsibility to work with your POMI to ensure that your deployment days are in the system (Access database). I know that there are internists out there with significantly more deployment time than is reflected in EMPARTS.From the EMPARTS database manager:“There have been questions recently concerning NON BSO-18 deployments (thosedeployments someone made with the USMC or a ship or other command prior tocoming to shore duty) and should they be entered into EMPARTS. The answer isYes and I would suggest you verify that they indeed made the deployment(normally there is something in their evals or they have otherdocumentation). This information is important when making decisions on whoshould be deployed. If you have someone who just came from sea duty andmade 3-4 deployments and someone else who has never been on a deployment,you might decide one way or another based on that information. If allcommands enter those NON BSO-18 deployments, it helps us all have a betterpicture of the individual.”Mike StewartProgram Manager DMHRSi, EMPARTS (Navy)Bureau of Medicine and Surgery (M-14)Jacksonville FL 32212Data source: EMPARTS 12 Oct 2014
29Deployment 50 Internists with >300 days of deployment 99 Internists with zero days of deployment (includes trainees)Navy Medicine tracks deployed days via EMPARTSNot a perfect database, requires manual data entryEnsure your deployments are correctly reflected in the systemData source: EMPARTS 28 Oct 2012Data source: EMPARTS 12 Oct 2014
30Deployment IM has/had habitual relationships for specific IAs Pacific PartnershipContinuing PromiseEMF Kandahar (pulm/cc)JTF GTMO (NE-2213)EMF Djibouti (NE-2089)Embedded Training Teams (NE-4255)Forward Surgical Teams (NE-5326, NE-5254)
31Deployment Forecast FY15 Discussion with POMIs, nothing imminentAny Surprises in Afghanistan next spring?Syria, ISIS, Ebola….Fiscal Climate affecting Humanitarian MissionsOur Primary Role Is to Support These Deployments. We all must be ready….
32DeploymentsFor 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?
33IM Deployment Business Rules No position is too important to deploy (except CO).No one shall be recommended for deployment until everyone has deployed a first time.Total deployed days taken in to account for deployment recommendationIn order to facilitate consolidation of knowledge and board passage, recently graduated fellows should be protected from deployment during their first post-GME year.Prior overseas PCS moves will not count towards IAs.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).Volunteers will always be solicited prior to assigning deployers.Volunteering for one assignment, does NOT move you higher on the list for the next available assignment.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.
34THANK YOU! Thank you for your professionalism Thank you for your hard work and dedication to our patientsThank you for constantly striving to improve Navy Medicine
35Points of Contact CDR Daniel Seidensticker IM Specialty Leader CDR Joel Schofer DetailerCAPT Harry Ward Reserve IM SL
38Also note, for a general internist each paRVU is worth $46 Also note, for a general internist each paRVU is worth $46.35 a Navy general internist to generate $88,899 in equivalent production MGMA report (below), Navy MGMA 40% targets (right)
39Promotion GuidanceProfessional GuidanceTiming of sub-specialty training must be considered if coming in to zone for O-5/O-6Ensure your photo is up to date, in current rank!Manage your online Officer record, OSR/PSRDocument accomplishments during FTOS trainingPublications, Research Presentations Class rankings
40From the OOMC FITREPs are written for Promotion Board members Professional GuidanceFITREPs are written for Promotion Board membersExpectationsAll MC Officers will complete residencyAll MC Officers will achieve board certificationO-6 board looks for demonstrated leadershipClinicalAcademicOperationalExecutivePass PRT/BCAFITNESSExtremely important because:a) As healthcare professionals we need to be fit and model healthy behaviorb) We are advisors and advocates for fitness to big Navyc) Supports readiness to deploy and support the warfighterd) Career implications - requirement for employment
41Change is coming to Navy Medicine Enhanced Multiservice Markets (eMSM’s)PUGET Sound, Hampton RoadsNational Capital RegionSan Antonio, National Capital, Colorado Springs, Pearl HarborNMCSD, Camp Lejeune considered their own mini marketsCO of that eMSM will have operational control of all facilities