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المحتوى المقدم من Joel Schofer, MD, MBA, and CPE. يتم تحميل جميع محتويات البودكاست بما في ذلك الحلقات والرسومات وأوصاف البودكاست وتقديمها مباشرة بواسطة Joel Schofer, MD, MBA, and CPE أو شريك منصة البودكاست الخاص بهم. إذا كنت تعتقد أن شخصًا ما يستخدم عملك المحمي بحقوق الطبع والنشر دون إذنك، فيمكنك اتباع العملية الموضحة هنا https://ar.player.fm/legal.
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Advances in Care
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1 Advancing Cardiology and Heart Surgery Through a History of Collaboration 20:13
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On this episode of Advances in Care , host Erin Welsh and Dr. Craig Smith, Chair of the Department of Surgery and Surgeon-in-Chief at NewYork-Presbyterian and Columbia discuss the highlights of Dr. Smith’s 40+ year career as a cardiac surgeon and how the culture of Columbia has been a catalyst for innovation in cardiac care. Dr. Smith describes the excitement of helping to pioneer the institution’s heart transplant program in the 1980s, when it was just one of only three hospitals in the country practicing heart transplantation. Dr. Smith also explains how a unique collaboration with Columbia’s cardiology team led to the first of several groundbreaking trials, called PARTNER (Placement of AoRTic TraNscatheteR Valve), which paved the way for a monumental treatment for aortic stenosis — the most common heart valve disease that is lethal if left untreated. During the trial, Dr. Smith worked closely with Dr. Martin B. Leon, Professor of Medicine at Columbia University Irving Medical Center and Chief Innovation Officer and the Director of the Cardiovascular Data Science Center for the Division of Cardiology. Their findings elevated TAVR, or transcatheter aortic valve replacement, to eventually become the gold-standard for aortic stenosis patients at all levels of illness severity and surgical risk. Today, an experienced team of specialists at Columbia treat TAVR patients with a combination of advancements including advanced replacement valve materials, three-dimensional and ECG imaging, and a personalized approach to cardiac care. Finally, Dr. Smith shares his thoughts on new frontiers of cardiac surgery, like the challenge of repairing the mitral and tricuspid valves, and the promising application of robotic surgery for complex, high-risk operations. He reflects on life after he retires from operating, and shares his observations of how NewYork-Presbyterian and Columbia have evolved in the decades since he began his residency. For more information visit nyp.org/Advances…
Personal Finance for the New Attending
Manage episode 178996554 series 1104366
المحتوى المقدم من Joel Schofer, MD, MBA, and CPE. يتم تحميل جميع محتويات البودكاست بما في ذلك الحلقات والرسومات وأوصاف البودكاست وتقديمها مباشرة بواسطة Joel Schofer, MD, MBA, and CPE أو شريك منصة البودكاست الخاص بهم. إذا كنت تعتقد أن شخصًا ما يستخدم عملك المحمي بحقوق الطبع والنشر دون إذنك، فيمكنك اتباع العملية الموضحة هنا https://ar.player.fm/legal.
Here is an audio podcast of a 30 minute lecture I gave at Naval Medical Center San Diego’s Transition to Practice Symposium that they put on last week for all the graduating residents and fellows. I hope you enjoy it.
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Manage episode 178996554 series 1104366
المحتوى المقدم من Joel Schofer, MD, MBA, and CPE. يتم تحميل جميع محتويات البودكاست بما في ذلك الحلقات والرسومات وأوصاف البودكاست وتقديمها مباشرة بواسطة Joel Schofer, MD, MBA, and CPE أو شريك منصة البودكاست الخاص بهم. إذا كنت تعتقد أن شخصًا ما يستخدم عملك المحمي بحقوق الطبع والنشر دون إذنك، فيمكنك اتباع العملية الموضحة هنا https://ar.player.fm/legal.
Here is an audio podcast of a 30 minute lecture I gave at Naval Medical Center San Diego’s Transition to Practice Symposium that they put on last week for all the graduating residents and fellows. I hope you enjoy it.
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1 How to Evaluate the Promotion Potential of a Billet/Position 2:56
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Recently I advertised the USUHS Commandant position . A reader asked: Any thoughts on whether you think this is a position that would make an O5 competitive for O6? This is a common issue. A position is advertised, but you want to know if it will help get your promoted to O5 or O6 if you take it. Here is how I’d evaluate that situation. First, you need to contact the incumbent in that position now, if possible. You’re going to need information that they have. Now that you’ve contacted that person, you need to ask them some questions: Did they or anyone before them promote to O5/O6 while they were in the position or shortly thereafter? In other words, has taking the position led to promotion for those who’ve already done it? If the answer is yes, that is telling and indicative that the position advances people’s careers. If the answer is no, you should probably look elsewhere for a career advancing position. How large is their competitive group on their fitreps? You want a position with a large competitive group so that you can perform well and break out to the right with MP and EP fitreps. Competitive EP fitreps are probably the #1 most important ingredient for successful promotion, so if the position has a small competitive group or leads to a 1/1 fitrep, it would be a mark against that position’s potential to get you promoted. Were they able to get EP fitreps? They might not tell you this, but if they are willing to give you this info it can help you gauge the potential for you to get EP fitreps while doing the job. What do your mentors think about you taking the position? We all need mentors, and I always ask mine what they think when a potential position is in my crosshairs. If they don’t think it is a good idea, I usually pass on it. That’s it. Those are the things I’d look at when trying to evaluate whether or not a position will help you get promoted. Most of the information needs to come from the incumbent or people who have previously done the job. https://mccareer.org/wp-content/uploads/2018/10/episode-62-how-to-evaluate-the-promotion-potential-of-a-billetposition.mp3…
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1 What Should You Do If You Didn’t Promote? 11:42
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If you are particularly interested in this post, I’m sorry. You or someone you care about probably failed to promote. In reality, nowadays it is normal and expected to fail to promote to O5 and O6, so you have company. Here are my suggestions for those that fail to promote. First, try to figure out why you didn’t promote. Because the promotion board members are not allowed to speak about your board, you’ll never actually find out why you failed to promote, but you can usually take a pretty educated guess if you talk to the right people ( like me ). If any of these things happened to you, they are likely a main reason you didn’t promote: Any PFA/BCA failures. Legal issues, such as a DUI or any other legal trouble. Failure to become board certified. There are other things that could happen to you that make it difficult but not impossible to promote. They include: Coming into zone while in you were in GME. Having non-observed (NOB) fitreps before the board, such as those in full-time outservice training. Spending too much time in the fleet as a GMO, Flight Surgeon, or UMO. This is mostly because it causes you to come into zone for O5 while you are still in GME, and is more of a problem if your residency is long. Never getting a competitive early promote (EP) fitrep. Many officers who fail to select have never had a competitive EP fitrep in their current rank. This can be because they were stationed places without competitive groups and they get 1/1 fitreps, or it can be because they were in a competitive group and did not break out and get an EP. To me this is the #1 ingredient to promote…competitive EP fitreps. If you don’t have them, you are really up against it. Receiving potentially adverse fitreps. This most commonly happens when you are at an operational command and your reporting senior is not someone who is used to ranking Medical Corps officers, although it could happen for other reasons (like your reporting senior felt you deserved this type of fitrep). The most common situation would be if there is a competitive group of 2 officers but both are given must promote (MP) fitreps instead of 1 getting an EP and the other the MP. When both get an MP, it reflects poorly on both officers unless the reason for this is CLEARLY explained in the fitrep narrative, which it often is not. The other thing that happens is that a reporting senior gives you a 1/1 MP instead of a 1/1 EP. If you are ever getting a 1/1 fitrep, make sure you get an EP. You should consider getting a 1/1 MP an adverse fitrep. If there is no way around this, often because the reporting senior has a policy that they don’t give newly promoted officers an EP, make sure that this policy is clear in the fitrep narrative. Having a declining fitrep. Mostly this happens when you go from getting an EP to an MP on your fitrep under the same reporting senior. If it is because you changed competitive groups, like you went from being a resident to a staff physician, that is understandable and not a negative. If you didn’t change competitive groups, though, make sure the reason you declined is explained. Making it obvious to the promotion board that you didn’t update your record. The most obvious ways a promotion board will know you didn’t update your record is if your Officer Summary Record (OSR) is missing degrees that you obviously have (like your MD or DO) or if many of the sections of your OSR are either completely blank or required updating by the board recorders. Remember that although promotion board recorders will correct your record for you, anything they do and any corrections they make are annotated to the board. While a few corrections are OK, you don’t want a blank record that the recorders had to fill in. It demonstrates that you didn’t update your record. So who actually promotes to O5 and O6? In general, the officer who promotes is: Board certified. Has a demonstrated history of excellence as an officer. In other words, whenever they are in a competitive group, they successfully break out and get an EP fitrep. Being average is just not good enough anymore. They have no PFA failures, legal problems, declining fitreps, or potentially adverse fitreps. They have updated their record, and if they previously failed to select they reviewed their record with their Detailer and actively worked to improve it. So what do you do if you were passed over and failed to promote? Realize that it is not the end of the world. Based on the recent promotion board statistics (which you can get in the Promo Prep ), most officers were passed over for O5 or O6, but a large number of the officers selected were from the above zone group. If you do nothing, you will continue to get looked at by promotion boards until you retire, resign, or are forced out of the Navy. There is no limit to the number of chances you get to promote and your record will be evaluated for promotion every year. That said… You need to try to promote. Consider sending a letter to the promotion board. What do you say in this letter? First, briefly state that you want to be promoted and to continue your career in the Navy. Second, explain what a promotion would allow you to do that you can’t do at your current rank. Answer the question, “Why should they promote you?” For example, if you want to be a Department Head at a large military treatment facility (MTF) or a Residency Director (or whatever you want to do), tell them that you need to be promoted to be competitive for these jobs. The Navy wants to promote leaders. Make it clear to them that you are a motivated future leader. Try and get letters of support to attach to your letter. These letters should be from the most senior officers who can personally attest to your value to the Navy. In other words, it is probably better to get a letter from an O6 who knows you well than a 3 star who doesn’t. If you are not sure who to ask for letters, ask those more senior to you or your Detailer for advice. Your Specialty Leader is always someone to consider if he/she knows you well and can speak to your contributions to the specialty and Navy. Have your record reviewed by your Detailer, Specialty Leader, other trusted senior advisor, or by me . Because of promotion board confidentiality, you will never know the reason(s) you did not promote, but most of the time experienced reviewers can come up with an educated guess. They’ll often find things that you were not even aware of, like potentially adverse fitreps, or information missing from your record. My promo prep document will help you as well. Do everything you can to get “early promote” or “EP” fitreps. This is largely accomplished by continually striving for positions of increased leadership. You need to get a job that has historically led to a promotion. As a LCDR who got passed over for CDR, try to get one of these jobs and excel at it (this list is not exhaustive and these positions are not the only path to CDR, but they are a good start): Assistant/Associate Residency Director Department Head at a small/medium sized MTF Senior Medical Officer or Medical Director Chair of a hospital committee MEC member If you are a CDR who got passed over for CAPT, try to get one of these jobs and excel at it: Residency Director Department Head in a large MTF Associate Director or Director Officer-in-Charge (OIC) MEC President Division, Group, or Wing Surgeon CATF Surgeon Specialty Leader Chief Medical Officer (CMO) Meet with your chain-of-command. After you’ve been passed over is not the time to be passive. You need to sit down with your leadership and get an honest assessment from them of how you’re doing and what they would recommend continuing to advance your career. You may not like what you hear, but it is better to find out early if they don’t think you’re doing a good job or that you are unlikely to break out on your fitreps. That way you can try and put yourself in a better situation by changing commands. In addition to the above list of things you should do, there are a few things you should not do: Do not lie in your letter to the board. In other words, don’t tell them you want to do Executive Medicine if you don’t really want to. Your record reads like a book, and if it tells a story that is contrary to what your letter says, this is unlikely to help you and may hurt you. Do not send long correspondence. Promotion boards have to read everything sent to them, and a long letter may not be appreciated. Keep it brief and to the point. Do not ask your current CO to write you a letter to the board if they’ve done an observed fitrep on you. His or her opinion about you should be reflected on that fitrep, so they don’t need to write you a letter. If they’ve never given you an observed fitrep or there is some new information not reflected on prior fitreps, they could either write you a letter or give you a special fitrep. Ultimately it is up to them whether they do either of these or none. Do not discuss anything adverse unless you want the board to notice and discuss it. This issue comes up frequently and people will ask me for advice, but ultimately it is up to the individual officer. The one thing I can guarantee is that if you send a letter to the board and discuss something adverse, they will notice it because they will read your letter! If you think there is a chance the adverse matter will get overlooked, it is probably better not to mention it and keep your fingers crossed. Those are my tips for those who find themselves above zone. Most importantly, if you want to promote, NEVER STOP TRYING . You can stay in as a LCDR for 20 years, and I personally know of people who got promoted their 9th look! https://mccareer.org/wp-content/uploads/2017/07/episode-55-what-to-do-if-you-fail-to-promote.mp3…
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1 You Should Care About Promotion Board Precepts and Convening Orders 3:43
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Whenever a promotion board starts, the members are provided two items to guide them as they decide who to promote, the board precept and the convening order. These documents are available on-line and should be used to figure out how to promote and write your fitrep. The Board Precept The precept is released in December and can be seen anytime afterwards. For example, if you go to the FY19 O4 Staff Corps Promotion Board page and click on the link marked with an arrow, you’ll get the board precept even though this board hasn’t started yet: The Convening Order The convening order for a promotion board is not released until it starts. If you monitor the board page closely, you’ll usually be able to get it within 1-2 days after the board begins. You just click the link that reads “Board Convening Order”: Incidentally, this is how I always find out the promotion opportunity for all the boards and post it on the blog. It is in the convening order. Why You Should Care You should care about the precept and convening order because they tell you how to promote to the next rank. Go to this page and download them from the most recent boards of your next rank. You can see all the different boards circled in red here: Click on the board for the next rank you’ll be competing for, and download the precept and convening order. If the board hasn’t happened yet (like the FY19 O4 board), then you’ll have to look at last year’s convening order (FY18). Use these documents for two things. First, to figure out how to promote. For example, I deconstructed a past O6 convening order here . Second, use them to come up with wording for your fitrep bullets, as discussed here where I showed you how to pull phrases for your block 41. The Bottom Line Go to this page . Get the precept and convening order for your next rank. You might have to go to last year’s board for the convening order if the board hasn’t started yet. Use them to figure out how to get promoted and for writing your fitrep. https://mccareer.org/wp-content/uploads/2018/04/episode-61-why-you-should-care-about-promotion-board-precepts-and-convening-orders.mp3…
O5 fitreps are due soon, so it is time for me to write my fitrep. How do I do it? Here are the steps I go through: I get the Surgeon General’s priorities and the convening order for last year’s O6 board . (If you were an O4, you’d want the O5 convening order . If you are an O3, you’d want the O4 convening order .) I read through them, highlighting the important language (similar to what I did in this very popular post ). I do this because I use this exact language to take my accomplishments and frame them in the setting of strategic Navy initiatives. This allows me to demonstrate Navy-wide impact, which is the goal when you are trying to prove to people that you deserve to promote. I take my CV, which is the document I use to track my accomplishments, and I edit it so that it only includes what I did during the time period covered by the fitrep. Here’s what was left , which is what I use to build my blocks 29 and 41. I print out a copy of my last fitrep. I download the Word template you use when drafting a block 41 . This template eliminates some of the spacing issues you run into when printing your fitrep only to find that the last line of your block 41 narrative isn’t there anymore. I boot up NAVFIT98A and I start writing the fitrep, as outlined in Joel Schofer’s Fitrep Prep . Once I have a draft ready, I put it aside for 24 hours and/or have someone else who I trust read over it. Having a mentor or two take a look is always a good idea. I read it one more time, ensuring that I spell checked it. I submit it up the chain of command. That’s it! https://mccareer.org/wp-content/uploads/2018/01/episode-60-how-i-write-my-fitrep.mp3…
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1 Do You Still Need to Send the Above Zone Letter? 2:46
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The standard advice has always gone something like this: “If you are above zone, you need to send a letter to the promotion board so that they know you are still trying to promote. Otherwise they won’t pick you.” Now that they no longer stamp officer records with “AZ” (above zone) and they look exactly the same as those records that are in zone, do you still need to write a letter to the board? Has the standard advice changed? Reasons to Send a Letter to a Promotion Board I addressed this in a post from a few years ago entitled “ Should You Send a Letter to the Promotion Board? ” I still agree with just about everything in that post, except for this: “…you should always send a letter to demonstrate interest in getting promoted when you are above zone.” In my opinion, you no longer need to send a letter just because you are above zone. If you have another reason to send a letter, then please do. If you are just sending one because you think you have to, I think that is no longer necessary. The FY18 O6 board convening order states on page 2: “…in determining which officers are best and fully qualified for promotion, you are required to equally consider both above-zone and in-zone officers.” What if You’re Not Sure? As you might imagine, I get asked a lot whether someone should send a letter to the promotion board. This is my standard response… Pretend that you did not send a letter to the board, the board is over, and you were not selected for promotion. Are you going to be kicking yourself for not sending the letter? If the answer is yes or maybe, then send the letter. As long as you keep it short and sweet, there is no real downside. Frankly, I think that when officers send letters to promotion boards they are often just making themselves feel better, and there is nothing wrong with that. You want to make sure that when the promotion board results come out, no matter what happened, you feel like you did everything you could to get promoted. The Bottom Line If you are above zone and want to send the letter just so there is no regret, feel free, but it is definitely not required to be considered for promotion. https://mccareer.org/wp-content/uploads/2018/01/episode-59-do-you-still-need-to-send-the-above-zone-letter.mp3…
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1 New Addition to the Promo Prep – Check Your Security Clearance 2:50
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During the last Specialty Leader Business Meeting, the Detailing Update mentioned that there were about 10 cases of officers who lost their promotion due to a security clearance issue. As a result, I added a new section to the Promo Prep document . In it you can find out how to check your security clearance. Here’s what I added: Step 8 – Check Your Security Clearance If your security clearance is expired, you won’t promote. To check on its status, go to blocks 92 and 93 of your Officer Data Card (ODC). Here is what mine says: Block 92 – VV1015 Block 93 – 1115 What does this mean? The letters and dates in order are the level of clearance you are eligible for, the level of clearance you have, the date your investigation was initiated (MMYY format), and in block 93 the date your clearance was granted (MMYY format). My first “V” means I am eligible for a “Top Secret – SCI Eligible” clearance. The second “V” means I actually have one. Here is a list of the various codes you might see: The second date in block 93, “1115” in my case, is the important one. A Top Secret clearance is good for 6 years, so I should be good until NOV 2021. A Secret clearance, which is what most of you will have, is good for 10 years. If your security clearance will expire within the next year or you have any questions about this, you should go to your security manager to renew it. Don’t let a promotion slip by because you had an expired clearance. It happens more than you would think. https://mccareer.org/wp-content/uploads/2018/01/episode-58-a-new-addition-to-the-promo-prep-how-to-check-your-security-clearance.mp3…
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1 How to Prepare for Important Navy Interviews 5:03
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A reader recently asked me for help preparing for a big interview that I had done in the past (the interview to become a Specialty Leader). We both thought that interview prep would be a good blog post, so here is my advice after 10+ interviews for significant leadership positions: Be prepared for an in-depth and long interview. My interview for Specialty Leader was with VADM Bono when she was a two star and the Navy Medical Corps Chief. It thought that it was going to be 15-20 minutes with a max of 30 minutes because she was (is) so busy. She talked to me for an hour and 15 minutes and it was a very, very thorough and in-depth interview. Although I got the position, I probably should have been more mentally prepared for the possibility that it could have lasted over an hour. Always have a reasonable understanding about the current state of the position you are interviewing for. I ensure this by talking with the incumbent for at least 15 minutes about the position. Ask how it is going, what they liked or didn’t like about it, what has gone well and what hasn’t, etc. In addition, try to meet with their immediate supervisor to ask them a few questions about the position. I try to find out what they would like out of the position in the future, what they need more of, and what their strategic priorities are. Make sure you’ve read all of the core strategic documents. To me, these include the Navy Medicine Commander’s Guidance ( Short Version and Long Version ), the DHA Director’s Priorities and Vision , and your command’s mission/vision statements. There may be others, depending on what you’re interviewing for. For example, I like this article on Value Based Healthcare . If given the position, always have a plan for what you want to do in the future. Ideally, your plan needs to support the strategic documents in #3 above. Tell the truth and be honest to yourself. In other words, don’t try to be who you think they want. Be who you are. If you’re not what they want, it is probably better if you don’t get the job anyway. As soon as you are done with the interview, write down the questions they asked. Then you can use these questions to prepare for future interviews. The list of questions I’ve been asked in the last few years include: What do you see as the role of (insert whatever position you’re interviewing for)? What has prepared you for this position? How do you see yourself in this position supporting the Surgeon General’s strategic initiatives? What do you see as the role of the senior enlisted leader? Describe your leadership style. How would you handle a disagreement between you and the CO? How do you handle it when you make a decision and someone who works for you disagrees with you? How would you handle the multiple priorities associated with being a director, especially as it relates to GME? How do you see your role on the Executive Steering Committee/Command Evaluation Board? What are your top 3 priorities? What are some of the challenges you’ve faced and how have they impacted you as a leader? How do you think you and your direct boss/supervisor will work together? What part of the directorate is most interesting to you? Why did you apply for this job? What are your biggest leadership challenges? How do you handle disagreement or conflict? Tell me about your leadership style. As soon as the results of the interview are released, no matter whether you got the position or not, always ask a few of your interviewers for feedback so you can grow professionally. They’re usually happy to give both positive and negative feedback. https://mccareer.org/wp-content/uploads/2017/12/episode-57-how-to-prepare-for-important-navy-interviews.mp3…
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1 What Should You Do If You Didn’t Promote? 11:42
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If you are particularly interested in this post, I’m sorry. You or someone you care about probably failed to promote. In reality, nowadays it is normal and expected to fail to promote to O5 and O6, so you have company. Here are my suggestions for those that fail to promote. First, try to figure out why you didn’t promote. Because the promotion board members are not allowed to speak about your board, you’ll never actually find out why you failed to promote, but you can usually take a pretty educated guess if you talk to the right people ( like me ). If any of these things happened to you, they are likely a main reason you didn’t promote: Any PFA/BCA failures. Legal issues, such as a DUI or any other legal trouble. Failure to become board certified. There are other things that could happen to you that make it difficult but not impossible to promote. They include: Coming into zone while in you were in GME. Having non-observed (NOB) fitreps before the board, such as those in full-time outservice training. Spending too much time in the fleet as a GMO, Flight Surgeon, or UMO. This is mostly because it causes you to come into zone for O5 while you are still in GME, and is more of a problem if your residency is long. Never getting a competitive early promote (EP) fitrep. Many officers who fail to select have never had a competitive EP fitrep in their current rank. This can be because they were stationed places without competitive groups and they get 1/1 fitreps, or it can be because they were in a competitive group and did not break out and get an EP. To me this is the #1 ingredient to promote…competitive EP fitreps. If you don’t have them, you are really up against it. Receiving potentially adverse fitreps. This most commonly happens when you are at an operational command and your reporting senior is not someone who is used to ranking Medical Corps officers, although it could happen for other reasons (like your reporting senior felt you deserved this type of fitrep). The most common situation would be if there is a competitive group of 2 officers but both are given must promote (MP) fitreps instead of 1 getting an EP and the other the MP. When both get an MP, it reflects poorly on both officers unless the reason for this is CLEARLY explained in the fitrep narrative, which it often is not. The other thing that happens is that a reporting senior gives you a 1/1 MP instead of a 1/1 EP. If you are ever getting a 1/1 fitrep, make sure you get an EP. You should consider getting a 1/1 MP an adverse fitrep. If there is no way around this, often because the reporting senior has a policy that they don’t give newly promoted officers an EP, make sure that this policy is clear in the fitrep narrative. Having a declining fitrep. Mostly this happens when you go from getting an EP to an MP on your fitrep under the same reporting senior. If it is because you changed competitive groups, like you went from being a resident to a staff physician, that is understandable and not a negative. If you didn’t change competitive groups, though, make sure the reason you declined is explained. Making it obvious to the promotion board that you didn’t update your record. The most obvious ways a promotion board will know you didn’t update your record is if your Officer Summary Record (OSR) is missing degrees that you obviously have (like your MD or DO) or if many of the sections of your OSR are either completely blank or required updating by the board recorders. Remember that although promotion board recorders will correct your record for you, anything they do and any corrections they make are annotated to the board. While a few corrections are OK, you don’t want a blank record that the recorders had to fill in. It demonstrates that you didn’t update your record. So who actually promotes to O5 and O6? In general, the officer who promotes is: Board certified. Has a demonstrated history of excellence as an officer. In other words, whenever they are in a competitive group, they successfully break out and get an EP fitrep. Being average is just not good enough anymore. They have no PFA failures, legal problems, declining fitreps, or potentially adverse fitreps. They have updated their record, and if they previously failed to select they reviewed their record with their Detailer and actively worked to improve it. So what do you do if you were passed over and failed to promote? Realize that it is not the end of the world. Based on the recent promotion board statistics, most officers were passed over for O5 or O6, but a large number of the officers selected were from the above zone group. If you do nothing, you will continue to get looked at by promotion boards until you retire, resign, or are forced out of the Navy. There is no limit to the number of chances you get to promote and your record will be evaluated for promotion every year. That said… You need to try to promote. Consider sending a letter to the promotion board. What do you say in this letter? First, briefly state that you want to be promoted and to continue your career in the Navy. Second, explain what a promotion would allow you to do that you can’t do at your current rank. Answer the question, “Why should they promote you?” For example, if you want to be a Department Head at a large military treatment facility (MTF) or a Residency Director (or whatever you want to do), tell them that you need to be promoted to be competitive for these jobs. The Navy wants to promote leaders. Make it clear to them that you are a motivated future leader. Try and get letters of support to attach to your letter. These letters should be from the most senior officers who can personally attest to your value to the Navy. In other words, it is probably better to get a letter from an O6 who knows you well than a 3 star who doesn’t. If you are not sure who to ask for letters, ask those more senior to you or your Detailer for advice. Your Specialty Leader is always someone to consider if he/she knows you well and can speak to your contributions to the specialty and Navy. Have your record reviewed by your Detailer, Specialty Leader, other trusted senior advisor, or by me . Because of promotion board confidentiality, you will never know the reason(s) you did not promote, but most of the time experienced reviewers can come up with an educated guess. They’ll often find things that you were not even aware of, like potentially adverse fitreps, or information missing from your record. My promo prep document will help you as well. Do everything you can to get “early promote” or “EP” fitreps. This is largely accomplished by continually striving for positions of increased leadership. You need to get a job that has historically led to a promotion. As a LCDR who got passed over for CDR, try to get one of these jobs and excel at it (this list is not exhaustive and these positions are not the only path to CDR, but they are a good start): Assistant/Associate Residency Director Department Head at a small/medium sized MTF Senior Medical Officer or Medical Director Chair of a hospital committee MEC member If you are a CDR who got passed over for CAPT, try to get one of these jobs and excel at it: Residency Director Department Head in a large MTF Associate Director or Director Officer-in-Charge (OIC) MEC President Division, Group, or Wing Surgeon CATF Surgeon Specialty Leader Meet with your chain-of-command. After you’ve been passed over is not the time to be passive. You need to sit down with your leadership and get an honest assessment from them of how you’re doing and what they would recommend continuing to advance your career. You may not like what you hear, but it is better to find out early if they don’t think you’re doing a good job or that you are unlikely to break out on your fitreps. That way you can try and put yourself in a better situation by changing commands. In addition to the above list of things you should do, there are a few things you should not do: Do not lie in your letter to the board. In other words, don’t tell them you want to do Executive Medicine if you don’t really want to. Your record reads like a book, and if it tells a story that is contrary to what your letter says, this is unlikely to help you and may hurt you. Do not send long correspondence. Promotion boards have to read everything sent to them, and a long letter may not be appreciated. Keep it brief and to the point. Do not ask your current CO to write you a letter to the board if they’ve done an observed fitrep on you. His or her opinion about you should be reflected on that fitrep, so they don’t need to write you a letter. If they’ve never given you an observed fitrep or there is some new information not reflected on prior fitreps, they could either write you a letter or give you a special fitrep. Ultimately it is up to them whether they do either of these or none. Do not discuss anything adverse unless you want the board to notice and discuss it. This issue comes up frequently and people will ask me for advice, but ultimately it is up to the individual officer. The one thing I can guarantee is that if you send a letter to the board and discuss something adverse, they will notice it because they will read your letter! If you think there is a chance the adverse matter will get overlooked, it is probably better not to mention it and keep your fingers crossed. Those are my tips for those who find themselves above zone. Most importantly, if you want to promote, NEVER STOP TRYING . You can stay in as a LCDR for 20 years, and I personally know of people who got promoted their 9th look! https://mccareer.org/wp-content/uploads/2017/07/episode-55-what-to-do-if-you-fail-to-promote.mp3…
(Here is a pdf of this article , one of my personal finance columns I write for a national Emergency Medicine newsletter. Find more of them here .) I cut a check and paid off my mortgage in February, making me debt-free. It cut my living expenses by about a third and ensured that in four years, at the age of 45, I’ll be financially independent and eligible for military retirement. What a glorious feeling! Should you pay off your mortgage as soon as you can? Benefits of Paying Off Your Mortgage You have one less thing to worry about! You’ve got food. You’ve got water. Now you’ve locked in your shelter and may be debt-free on top of that. You can move from “safety” to “love and belonging” on Maslow’s hierarchy of needs. It reduces your fixed monthly expenses, which goes a long way toward setting you up for retirement, fewer shifts, or even an alternative career path. Housing is usually a large percentage of your monthly expenses, and everyone who decides to purchase their primary domicile should make being mortgage-free a major goal by the time of retirement. It saves you money, since you’ll likely save tens of thousands of dollars in interest you otherwise would have paid. In addition, if you no longer have a mortgage you should be able to reduce the amount of life and disability insurance you are paying for each month. Without a mortgage, you can save and invest more money every month. Before I paid off my mortgage I saved 30% of my gross income. I’m not sure how much I’ll save now, but it’ll be more than 30%. When you pay off your mortgage, you are getting a guaranteed rate of return on the investment. In my case, the rate on my mortgage was 3%. I’m usually in the 33% tax bracket, which means that every dollar I put toward paying off my mortgage earned me a guaranteed return of 2%. This is a remarkably similar return when compared to most low-risk bond yields in recent years. In fact, this is exactly why I paid off my mortgage. I wanted to have a small portion of my retirement savings in bonds, but it made no sense to own bonds that would pay me 3-4% while paying 3% on my mortgage. Paying down your mortgage is a reasonable substitute for buying bonds. There can be asset protection benefits to paying off your home loan. Some states provide unlimited asset protection for home equity, which makes it nearly impossible to lose your home if a lawsuit doesn’t go your way. Other states, however, protect very little of your home equity. If you want to see what your state protects, go to this link and look for each state’s “homestead exemption”: http://www.assetprotectionbook.com/forum/viewtopic.php?f=142&t=1566 If you are paying a financial advisor who charges you a fee based on a percentage of your assets under management, by taking some of those assets and using them to pay off your house you reduce your investment expenses. Benefits to Keeping Your Mortgage When you make your mortgage payment, some of it goes toward principle and increases the equity in your home. For me this was about $2000/month of forced savings. If you are not financially disciplined, making a mortgage payment will ensure that every month you are squirreling away at least a little bit of money. Mortgage rates are still near their all-time lows. If you can borrow money at 3-4% and invest it in something that will give you a higher net return, it makes sense to invest the money instead of paying off the mortgage. That said, you have to make sure that you actually invest the money. In addition, there are very few investments that guarantee a return greater than your mortgage. Actually, there probably aren’t any, because of the word “guarantee.” Yes – stocks, high-yield or corporate bonds, real estate, etc. will probably make more than 3-4%, and you can protect yourself by diversifying – but that is certainly not guaranteed. The after-tax mortgage rate you are paying may be below inflation. For example, my after-tax mortgage rate was 2%. If inflation had been above 2%, I would have been getting paid (in real terms) to borrow money! The value of real estate tends to rise with inflation but your mortgage payment is fixed, so when inflation increases the value of your house but your mortgage payment remains the same, you are paying the loan back with dollars that are worth less and less as time goes on. When your mortgage is paid off, you give up this benefit. What Should You Do? Like most financial decisions, situations vary and this decision can be complicated. The best on-line article I could find that goes through all the complexities of the issue, which my brief article does not, can be found here: https://financialmentor.com/financial-advice/pay-off-mortgage-early-or-invest/7478 You should always maximize contributions to your retirement accounts, pay off all non-mortgage debt that has a higher interest rate, and save for your children’s education before you consider paying your mortgage off early. But if you find yourself having taken care of all of this, and weighing investing in bonds versus paying off your mortgage, you can’t beat the peace of mind that comes with being mortgage-free! https://mccareer.org/wp-content/uploads/2017/06/episode-53-should-you-pay-off-your-mortgage.mp3…
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1 You Were Selected for Promotion to O5 or O6 – Should You Accept It? 4:07
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BLUF – If you are hoping to retire but are not willing to serve 3 years as a Commander or Captain, you should decline the promotion. (This is not applicable if you are resigning. Only if you are hoping to retire.) The policy regarding promotions and retirements is governed by OPNAVINST 1811.3A . If you are lucky enough to be selected for promotion to O5 or O6, you should be familiar with this instruction and make sure you are willing to spend 3 years as a CDR or CAPT before you plan to retire. Paragraph 4b of the OPNAVINST states: “Officers must satisfy the minimum active duty time-in-grade requirement to retire in the highest grade satisfactorily served…Officers who desire to retire before completion of the minimum time-in-grade requirement must decline appointment to the next higher grade. Officers who have accepted appointment to the next higher grade must satisfy the retired grade criteria in paragraph 7.” Seems like we need to go to paragraph 7… “7. Time-in-Grade Requirements. Unless retirement in the next inferior grade is directed by SECNAV for an officer or warrant officer under reference (c), then officers, warrant officers, and enlisted members retired voluntarily or transferred to the Fleet Reserve shall be retired in the highest grade satisfactorily held upon completion of the following time-in-grade requirements…Three years for an officer serving on active duty in pay grade O5 or O6.” Paragraph 5b states: “Unless waived by proper authority, approval of requests for voluntary retirement or transfer to the Fleet Reserve will normally be denied until an individual has completed: (1) The applicable time-in-grade requirements of paragraph 7;” In addition, paragraph 7e states: “COMNAVPERSCOM shall normally deny retirement requests or Fleet Reserve requests of members serving on active duty in, whose length of service in the highest grade held while on active duty does not meet the time-in-grade requirements specified above.” What’s the bottom line? There are certain exceptions spelled out in this policy, and you can get information on time-in-grade or next-lower-grade waivers here and here , but if you want to retire and accept promotion to CDR or CAPT you should be willing to serve in that rank for 3 years. Otherwise, you should decline the promotion. https://mccareer.org/wp-content/uploads/2017/05/episode-49-should-you-accept-promotion-to-o5-or-o6.mp3…
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1 Personal Finance for the New Attending 30:11
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Here is an audio podcast of a 30 minute lecture I gave at Naval Medical Center San Diego’s Transition to Practice Symposium that they put on last week for all the graduating residents and fellows. I hope you enjoy it. https://mccareer.org/wp-content/uploads/2017/05/episode-48-personal-finance-for-the-new-attending.mp3…
Recently Navy Personnel Command (PERS) has started enforcing some policies that had largely been ignored, and I’ve heard a few horror stories from people trying to resign from the Navy. With that in mind, here is how you can resign without encountering problems. Assuming that you’ve already decided to resign, here are the steps you need to take to make sure the ride is not a bumpy one. STEP 1 – Confirm Your Obligated Service Date There’s nothing like thinking you are eligible to get out only to find out that you are not. Your Detailer is your POC to figure out when you are eligible to resign. STEP 2 – Negotiate Your Date of Resignation and Terminal Leave With Your Command When you submit a resignation request to PERS, you specify the month you want to resign. The specific date and how much leave you get is between you and your command, not PERS. You need to approach your chain of command about the specific date you want to resign and how much leave they’ll give you. STEP 3 – Submit Your Paperwork 9-12 Months Ahead of Your Desired Month of Resignation This has always been the required timeline, but last minute requests were accommodated. Not anymore! PERS has recently reminded people of this timeline and widely advertised that any requests received less than 6 months before the desired resignation date will be returned to the officer and not processed. Because of this, you need to make your decision and then stick to the 9-12 month timeline. In addition, if you get within 6 months of your projected rotation date (PRD) and have not notified your Detailer of your intention to resign, he/she can write you orders whether you want to stay in or not! Don’t tempt the Detailer. If you are deploying and you’ll be gone during this timeframe, you need to get the paperwork ready before you leave. You can’t submit a request more than 12 months early, but you can certainly have it ready to go so that you submit it when you hit the 9-12 month window. STEP 4 – Track the Progress of Your Request Weekly The Navy is filled with officers who did not track the progress of their request and paid the price. Because your request has to go to PERS with the endorsement of your CO, it needs to go various places at your command before it is submitted. Realize that each stop in the chain of command is a potential place for it to get lost. STEP 5 – Make Sure Your Request is Submitted to PERS Most officers will have a personnel department of some kind that will submit their request for them, but just in case you don’t, here are the official instructions for how to submit the request from the PERS resignation website : “Resignation requests can be mailed to PERS-834F to the address listed below, by fax, or sent in PDF format by email to PERS-834F@navy.mil . Email submissions are highly recommended and preferred. All requests must be submitted 9-12 months prior to the desired separation date.” Address/Fax (Please adhere to PII requirements when sending documentation): COMMANDER NAVY PERSONNEL COMMAND PERS-834F 5720 INTEGRITY DRIVE MILLINGTON TN 38055-8340 PERS-834F fax number: (901) 874-2625 STEP 6 – Make Sure Your Request was Received by PERS Again, from the PERS website : “After sending your resignation request to PERS-834F, you and your current Command will receive confirmation via message traffic and BOL that your request has been received for processing. If you do not receive confirmation within 2 WEEKS after your Command has forwarded your request to PERS-834F, please call NPC’s customer service call center, 1-866-827-5672 for routing to PERS-834F.” STEP 7 – Check to Make Sure There are No Issues Every Few Months This will probably make the Detailers cringe, but oh well. It is their job to serve as your advocate, and I think you should touch base with them every two months or so until you have released resignation orders in your hand. That’s it! If you’re looking for templates for your request, you can find them here . https://mccareer.org/wp-content/uploads/2017/03/episode-46-how-to-resign-worry-free.mp3…
Thousands of times a year Navy physicians struggle to do something that no one really ever teaches them how to do…write their fitrep. I have read the Navy fitrep instruction, taken guidance I’ve received from senior Navy leaders and classes I’ve attended, and consolidated it into one document that you can read from start to finish when you need to write your fitrep. Click here for the latest version of Joel Schofer’s Fitrep Prep: Joel Schofer’s Fitrep Prep https://mccareer.org/wp-content/uploads/2017/01/episode-25-fitrep-prep.mp3…
The Graduate Medical Education Selection Board (GMESB) results were released last month with a 30 DEC deadline to accept or decline any spots you were offered. Undoubtedly there were some people who didn’t get what they want. I’ve participated in the last three GMESBs and would like to offer tips for people looking to match for GME in the future. We’ll cover general tips and those specific for internship and residency/fellowship: General Tips Money is getting tight for permanent change of station (PCS) moves at BUPERS. I think you can increase your chances of matching in GME by being local, or at least on the same coast, as the GME program where you want to train. Keep this in mind when you are picking your Flight Surgery (FS), Undersea Medical Officer (UMO), General Medical Officer (GMO), or post-residency assignments. You can increase your score at the GMESB by having publications. If you want to give yourself the best chance of maximizing your score, you need at least two peer-reviewed publications. Any publications or scholarly activity have the chance to get you points, but having two peer-reviewed publications is the goal you should be trying to reach. Be realistic about your chances of matching. If you are applying to a competitive specialty and you’ve failed a board exam or had to repeat a year in medical school, you are probably not going to match in that specialty. There are some specialties where you can overcome a major blight on your record, but there are some where you can’t. If this is applicable to you, the residency director or specialty leader should be able to give you some idea of your chances. Will they be honest and direct with you? I’m not sure, but it can’t hurt to ask. If you are having trouble matching in the Navy for GME, you may have a better chance as a civilian. By the time you pay back your commitment to the Navy, you are a wiser, more mature applicant that some civilian residency programs might prefer over an inexperienced medical student. You’ll also find some fairly patriotic residency programs, usually with faculty who are prior military, that may take you despite your academic struggles. Tips for Medical Students Applying for Internship Do everything you can to do a rotation with the GME program you want to match at. You want them to know who you are. When you are applying for internship, make sure your 2 nd choice is not a popular internship (Emergency Medicine, Orthopedics, etc.). If you don’t match in your 1st choice and your 2 nd choice is a popular internship, then it will likely have filled during the initial match. This means you get put in the “intern scramble” and you’ll likely wind up in an internship you didn’t even list on your application. Your backup plan if you don’t match should be an alternative program at the same site where you eventually want to match for residency. For example, in my specialty (Emergency Medicine or EM) we only have residencies at NMCP and NMCSD. If someone doesn’t match for an EM internship at NMCP or NMCSD, they will have a better chance of eventually matching for EM residency if they do an internship locally, like a transitional internship. Internships at Walter Reed or any other hospital without an EM program are quality programs, but it is much easier to pledge the fraternity if you are physically present and can get to know people, attending conferences and journal clubs when you can. You need to think about what you will do in your worst-case scenario, a 1-year civilian deferment for internship. Many of the medical students I interviewed did not have a plan if they got a 1-year deferment. I think every medical student needs to do one of two things. Either they should pick 10-15 civilian transitional year internships (or whatever internship they want) and apply to those just in case they get a 1-year deferment, or they should just plan to apply to internships late or scramble if this unlikely event happens to you. Most medical students do not grasp the concept that this could happen to them and have no plan to deal with it if it does. It is an unlikely event, especially if you are a strong applicant, and you can always just scramble at the last minute, but this is an issue that every medical student should think through. If you are going to just scramble at the last minute, that is fine, but it should be an informed choice. Tips for Officers Applying for Residency or Fellowship You should show up whenever you can for conferences and journal clubs. Again, you want them to know who you are and by attending these events when you can you demonstrate your commitment to the specialty and their program. Always get a warfare device (if one is available) during your FS, UMO, or GMO tour. Not having it is a red flag. https://mccareer.org/wp-content/uploads/2017/01/episode-44-tips-for-matching-in-gme.mp3…
This post will help you learn all that you can about deployments. Personally, I’ve done three deployments, one as a GMO during the initial invasion of Iraq, and two after residency. In 2010 I deployed with the 15 th Marine Expeditionary Unit or MEU and earlier this year I deployed to GTMO. In addition, as both a Detailer and Emergency Medicine Specialty Leader I’ve deployed a number of physicians, so I’m pretty familiar with all the details of the current deployment situation. In the current operational environment, there are a few types of deployments. They include platform-based deployments, individual augmentee or IA deployments, global support agreement or GSA deployments, and what I’ll call parent unit deployments. Let’s deal with the last one first because it is the easiest to explain. For what I’ll call a parent unit deployment, you deploy when your parent unit deploys. For example, if you are assigned to the Marine Corps with a MEU, when that MEU deploys so do you. You go with the unit you are primarily assigned to. The same could be said for a medical battalion, a Preventive Medicine Unit, and many other units. A platform-based deployment happens to people who are stationed at military treatment facilities or MTFs. Some people who are primarily stationed at MTFs are assigned to what is called a “platform.” A platform is an operational unit of some kind. It could be the Mercy or Comfort, a Marine Corps unit, an Expeditionary Medical Facility, a fleet hospital, etc. In essence, it is an operational unit who “owns” you if they get activated or deployed. In other words, if your platform is a medical battalion and that medical battalion gets deployed, you would go with them because it is your platform. If they don’t get deployed, you may never have to do anything for or with your platform. On the other hand, if your platform regularly drills or does exercises, since it is your platform you may have to participate in these drills and get pulled away from your primary duties at your hospital or MTF. How is it decided whether you get placed on a platform, and if so which one? The main determinant is most likely which billet you get orders into. Some billets at MTFs have secondary assignments to platforms. For example, the billet I am in at NMC Portsmouth is “mobilized to” or “MOB’ed to” an Expeditionary Medical Facility. That is my platform. To be honest, sometimes commands will rearrange platforms, so it is not always determined by the billet you are in. If you want to know if you are on a platform, you will have to go to your command’s Plans, Operations, Medical Intelligence or POMI officer. They are the ones who manage platforms and can tell you if you are on one. Platform based deployments are the wave of the future in Navy Medicine, and you can expect an increased focus on platforms, platforms training, and deployments as a platform. An individual augmentee or IA deployment is when a request in placed by an operational unit somewhere for an individual person, you are selected to fill that requirement, and you individually augment that unit. When they deploy, you deploy with them as an IA but stay attached administratively to your parent command. In other words, if you are at NMC Portsmouth but deploy as an IA, you stay attached to NMC Portsmouth the entire time you are deployed. This is the type of deployment most of us have experienced for the majority of our career, but the Navy is trying to get out of the “IA business” and is shifting, as already mentioned, to platforms. The final type of deployment is a global support assignment or GSA. With this type, you detach from your current command, move or execute a permanent change of station or PCS to a processing center that becomes your new military command, and then you are given orders to deploy. For example, my last deployment was a GSA. I detached from BUPERS, my old command, PCS’ed to my new command, the processing center in Norfolk, and then was given deployment orders to go to my unit in GTMO. During this time my parent command was Expeditionary Combat Readiness Center or ECRC, the processing center, and they were primarily responsible for my fitreps and pay issues. The unique part of a GSA deployment is that pretty much as soon as you report to the processing center you have to contact your Detailer and Specialty Leader to get orders to your next command. The GSA orders usually only last up to a year, and you’ll need orders so you can PCS to your next command when you get back from the deployment. This is the major downside that people complain about with a GSA…the fact that you get PCS orders and have to leave your old command, which people may not want to do. On the other hand, it can be a major benefit. If you are stationed somewhere you don’t want to be, volunteering for a GSA can get you out of there because you’ll PCS away. In addition, because you are volunteering or accepting a deployment, it may give you some leverage with the Detailer or Specialty Leader. For example, you could say, “I’ll deploy on this GSA, but only if you are willing to write me orders to Hawaii as follow-on orders.” That may not always work, but it is worth a try. Those are the major types of deployments that currently exist, and here are some additional resources: IA and GSA Frequently Asked Questions NAVADMIN 332-10 – IA Manpower Management Business Rules NAVADMIN 333-10 – IA-GSA Officer Business Rules 2007 Pay Entitlement Policy Interpretation and Clarification Pertaining to Members Serving in GWOT GSAs https://mccareer.org/wp-content/uploads/2016/11/episode-43-types-of-deployments.mp3…
مرحبًا بك في مشغل أف ام!
يقوم برنامج مشغل أف أم بمسح الويب للحصول على بودكاست عالية الجودة لتستمتع بها الآن. إنه أفضل تطبيق بودكاست ويعمل على أجهزة اندرويد والأيفون والويب. قم بالتسجيل لمزامنة الاشتراكات عبر الأجهزة.