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Internal Medicine Specialty Leader Update Navy ACP 2014
We are fortunate to have significant IM representation within Navy Medicine, including: SG Admiral Nathan OOMC Admiral Chin OAP Admiral Monahan NH Bremerton CAPT Culp NH Yokosuka CAPT Turner NHRC CAPT Utz Daniel Seidensticker, MD, FACP, FACC CDR, MC, USN
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Navy Medicine Mission We enable readiness, wellness, and health care to Sailors, Marines, their families, and all others entrusted to us worldwide – be it on land or at sea Where are we heading as a community? It’s important to know what the SG feels is important and to know his guiding principles. Vision Navy 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
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Navy Medicine Strategy Map
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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 RDML Brian Pecha Medical officer of Marine Corps In addition to the Surgeon General, we are fortunate to have significant IM representation within Navy Medicine, including: SG Admiral Nathan PA COM surgeon Admiral Chin OAP Admiral Monahan Pac Fleet CAPT Culp 5th Fleet CAPT Turner NMRC CAPT Sanders CAPT Mark Turner 5th Fleet surgeon CAPT John Sanders CO, Naval Medical Research Center CAPT Chris Culp Pacific Fleet Surgeon
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Deputy Medical Officer of USMC
CAPT Jeff Timby Deputy Medical Officer of USMC FMF Specialty Leader CAPT Kyle Petersen CO, NAMRU-6 Lima CAPT John Gilstad CO, NAMRU 3-Cairo EXECUTIVE OFFICERS: CAPT Michael McGinnis NH Guam CAPT Adam Armstrong NAMRU-6 Lima CAPT Fred Yeo Naval Submarine Medical Research Laboratory
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Internal Medicine Leads the Way
Who is your mentor? Whom are you mentoring? How should a mentor help you?
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Source: Worldbook october 2013
Medical Corps Manning Overall manning is 110% of billeted end strength Increased retention Normal attrition 10%/year Currently 8%/year Type Manning Billets Staff 2864 2471 GME 1009 1054 Total 3873 3524 Take-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 Corps GS + 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 mission Total MC billets in 2013: 3740 Total staff billets in 2013: 2706 Source: Worldbook october 2013
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Medical Corps Manning INTERNAL MED 111% By Specialty Specialty Manning
AEROSPACE MEDICINE 63% ANESTHESIA 136% AVIATION MEDICINE 98% DERMATOLOGY 109% DIAGNOSTIC RAD EMERGENCY MED 119% FAMILY PRACTICE 93% GENERAL MEDICINE 106% INTERNAL MED 111% NEURO SURG 120% NEUROLOGY 96% NUCLEAR MEDICINE 200% OB/GYN 107% Specialty Manning OCC MED 102% OPHTHAMOLOGY 111% ORTHOPEDIC SURG 113% OTOLARYNGOLOGY PATHOLOGY 98% PEDIATRICS PHYS MED & REHAB 200% PREV MED 100% PSYCHIATRY 92% RADIATION ONC 90% SURGERY 88% UNDERSEA MED 84% UROLOGY 103% Data source: the “World Book” BUMED (M13) Sep 2014
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Internal Medicine by Specialty
Manning Billets % Manning General IM 100 69+17 116 ID 34 31 110 Pulm/CCM 33 46 72 GI 24 20 120 Heme/Onc 13 12 108 Endo 9 8 113 Nephro 10 111 Rheum 7 5 140 Allergy 6 133 Card 36 29 124 Note, this data from sep 2014 Overmanning 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
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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
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From the OOMC RADM Raquel Bono CAPT Mae Pouget
Chief of the Medical Corps CAPT Mae Pouget Deputy Chief of the MC October 21 FACEBOOK TOWNHALL meeting with RADM Bono 21 October Joint 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.
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From the OOMC No change in special pays
Static since 2010 HPSP has met recruiting goal (FY08-14)
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From the OOMC MEDHOME Empanelment targets
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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
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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
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Professional Milestones
LT LCDR CDR CAPT Learn specialty Perfect specialty Teach specialty Leadership Residents and junior staff Majority board certified before CDR Board certification Large 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 tour Senior Clinician
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MC Promotion Opportunity
Medical Corps FY10 FY11 FY12 FY13 FY14 FY 15 Opportunity 80% 60% Selects 64 77 90 51 50 67 70% 145 123 100 106 111 100% 100%** 212 275 242 318 248 186 ** 88% in zone select rate
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FY14 Promotions - LCDR Zone Eligible Selected % AZ 13 4 36 IZ 186 168
FY14 O-4 Selection Results Zone Eligible Selected % AZ 13 4 36 IZ 186 168 90 BZ 442 14 3 Precept: 100% selection of IZ candidates 186 x = 186 = max # of selects 4 (AZ) (IZ) (BZ) = 186 IM: AZ 16/17 IZ; 1 BZ selected
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FY15 Promotions - CDR Zone Eligible Selected % AZ 92 33 36 IZ 159 78
FY15 O-5 Selection Results Zone Eligible Selected % AZ 92 33 36 IZ 159 78 49 BZ 373 Precept: 70% selection of IZ candidates 159x 0.7 = 111 = max # of selects 78 (IZ) + 33(AZ) = 111 IM: 66% IZ (10/15) AZ selected
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FY15 Promotions - CAPT AZ 138 14 10 IZ 112 53 47 BZ 208
FY15 O-6 Selection Results Zone Eligible Selected % AZ 138 14 10 IZ 112 53 47 BZ 208 “Precept: 60% selection of IZ candidates” 112 x = max # of selects 53(IZ) + 14(AZ) = 67 IM: 11/14 IZ /10 AZ 0/36 BZ
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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
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From the OOMC MilSuite One place to organize key data to answer frequent questions or find points of contact Reduce reliance on More communication between the hospitals We shouldn’t have to recreate the wheel
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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 ?? 79% of 06 selects had competitve EP’s 21% o6 selects were 1/1 96% board certified 69% of 06 selects it is consistently high performance in a variety of assignments with increasing leadership responsibilities.
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Unique Opportunities CAPT Matthew Lim LCDR Jamie Peterson CAPT Utz
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
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Billets 2015 Currently NMCP NMCSD WRNMMC NH Beaufort NH Camp Lejeune
NH Jacksonville NH 29 Palms NH Guam NH Okinawa NH Guantanamo NAMI (Pensacola) FHCC (Great Lakes) Bremerton
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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
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Top Internists Deployed Days
Deployments Top Internists Deployed Days 1 CAPT Tim Burgess 1704 2 CAPT Jim Radike 1258 3 CDR Brian Wells 766 4 CDR Yevsey Goldberg 735 5 LCDR Mark Zeller 712 6 CDR John Bassett 638 7 LCDR David Bailey 8 CAPT Walter Downs 567 9 CDR Michelle Perello 525 10 LCDR R Wilkerson 496 11 CDR Daniel Juba 488 12 LCDR Scott Liu 487 13 CAPT Kurt Henry 471 Navy Medicine personnel currently deployed: 262 (610) Pending deployment: 52 (331) Internists deployed: 9 (9) At this time 2011, 15 deployed Internists pending deployment: 4 15 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 (those deployments someone made with the USMC or a ship or other command prior to coming to shore duty) and should they be entered into EMPARTS. The answer is Yes and I would suggest you verify that they indeed made the deployment (normally there is something in their evals or they have other documentation). This information is important when making decisions on who should be deployed. If you have someone who just came from sea duty and made 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 all commands enter those NON BSO-18 deployments, it helps us all have a better picture of the individual.” Mike Stewart Program Manager DMHRSi, EMPARTS (Navy) Bureau of Medicine and Surgery (M-14) Jacksonville FL 32212 Data source: EMPARTS 12 Oct 2014
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Deployments 2013
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Deployment 50 Internists with >300 days of deployment
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 28 Oct 2012 Data source: EMPARTS 12 Oct 2014
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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)
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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….
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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?
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IM 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 recommendation In 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.
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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
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Points of Contact CDR Daniel Seidensticker IM Specialty Leader
CDR Joel Schofer Detailer CAPT Harry Ward Reserve IM SL
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Thank you for your service!
“Cogito ergo I.M.”
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Supplemental slides
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Also 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)
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Promotion Guidance Professional 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
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From the OOMC FITREPs are written for Promotion Board members
Professional Guidance 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 FITNESS Extremely important because: a) As healthcare professionals we need to be fit and model healthy behavior b) We are advisors and advocates for fitness to big Navy c) Supports readiness to deploy and support the warfighter d) Career implications - requirement for employment
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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
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