Internal Medicine Specialty Leader Update

Navy ACP 2014

Daniel Seidensticker, MD, FACP, FACCCDR, MC, USN

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

Navy Medicine Strategy Map

Internal Medicine Leads the Way

RADM Colin ChinnCommand Surgeon, US PaCom

RADM Brian MonahanThe Attending Physician for US

Congress and US Supreme Court

CAPT Chris CulpPacific Fleet Surgeon

CAPT Mark Turner5th Fleet surgeon

RDML Brian PechaMedical officer of Marine Corps

CAPT John SandersCO, Naval Medical Research Center

CAPT Kyle PetersenCO, NAMRU-6 Lima

CAPT John GilstadCO, NAMRU 3-Cairo

CAPT Jeff TimbyDeputy Medical Officer of USMC

FMF Specialty Leader

EXECUTIVE OFFICERS:CAPT Michael McGinnis NH GuamCAPT Adam Armstrong NAMRU-6 LimaCAPT Fred Yeo Naval Submarine Medical Research Laboratory

Internal Medicine Leads the Way

• Who is your mentor?

• Whom are you mentoring?

• How should a mentor help you?

Medical Corps Manning

Type Manning Billets

Staff 2864 2471

GME 1009 1054

Total 3873 3524

• Overall manning is 110% of billeted end strength

• Increased retention– Normal attrition 10%/year– Currently 8%/year

Source: Worldbook october 2013

Total MC billets in 2013: 3740

Total staff billets in 2013: 2706

Medical Corps Manning

Specialty Manning

AEROSPACE MEDICINE 63%

ANESTHESIA 136%

AVIATION MEDICINE 98%

DERMATOLOGY 109%

DIAGNOSTIC RAD 136%

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 113%

PATHOLOGY 98%

PEDIATRICS 111%

PHYS MED & REHAB 200%

PREV MED 100%

PSYCHIATRY 92%

RADIATION ONC 90%

SURGERY 88%

UNDERSEA MED 84%

UROLOGY 103%

By Specialty

Internal Medicine by Specialty

Specialty Manning Billets % Manning

General IM 100 69+17 116ID 34 31 110Pulm/CCM 33 46 72GI 24 20 120Heme/Onc 13 12 108Endo 9 8 113Nephro 10 9 111Rheum 7 5 140Allergy 8 6 133Card 36 29 124

Source: Worldbook Sep 2014

Is IM really overmanned?

• Probably close to being right sized• The billet structure is not current with hospital

needs– NH Camp Pendleton: 1 GIM billet, 5 IM staff– NH Beaufort: 1 GIM billet, 3 IM staff

• Several other Specialties have same issues

From the OOMC

• RADM Raquel Bono– Chief of the Medical Corps

• CAPT Mae Pouget– Deputy Chief of the MC

• October 21 FACEBOOK TOWNHALL meeting with RADM Bono– 21 October 1200-1300– https://www.facebook.com/USNavymedicine

From the OOMC• No change in special pays

– Static since 2010

• HPSP has met recruiting goal (FY08-14)

From the OOMC

• MEDHOME– Empanelment targets 1100-1300

Navy A

verag

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NMC Portsmouth

FHCC Grea

t Lak

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NH Beaufort

NH Camp Le

jeune

NH Jacks

onville

NH Pensac

ola

NHC Annapolis

NHC Charlest

on

NHC Cherry P

oint

NHC Corpus C

hristi

NHC New En

gland

NHC Patuxe

nt Rive

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NHC Quan

tico

USNH Guan

tanam

o Bay

USNH Nap

les

USNH Rota

USNH Si

gonell

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NMC San Dieg

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NH Bremert

on

NH Camp Pen

dleton

NH Lemoore

NH Oak

Harbor

NH Twen

tynine P

alms

NHC Hawaii

USNH Guam

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1,0001,2001,4001,6001,800

MedHome and the Neighborhood

• MGMA Standards based on 2012 report– 40% of nationwide average for each specialty

• Intentionally low to account for deployments, clinical inefficiencies

Conference Travel

– Google “bumed travel policy”

– “Mission critical” to attend conferences (board review ‘courses’ already approved)

– ALL attendees MUST be named with conference submission package.

– EACH ATTENDEE must be mission critical reason– Commands are referring to submitted lists

Professional Milestones

LT LCDR CDR CAPTLearn 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 membershipCredentials, 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

MC Promotion Opportunity

Medical Corps FY10 FY11 FY12 FY13 FY14 FY 15

Opportunity 80% 80% 80% 60% 60% 60%

Selects 64 77 90 51 50 67

Opportunity 80% 80% 80% 80% 80% 70%

Selects 145 123 100 106 145 111

Opportunity 100% 100% 100% 100% 100%** 100%

Selects 212 275 242 318 248 186

** 88% in zone select rate

FY14 Promotions - LCDR

• Precept: 100% selection of IZ candidates• 186 x 1.0 = 186 = max # of selects• 4 (AZ) + 168 (IZ) + 14 (BZ) = 186

• IM: 0 AZ 16/17 IZ; 1 BZ selected

Zone Eligible Selected %

AZ 13 4 36IZ 186 168 90BZ 442 14 3

FY14 O-4 Selection Results

http://www.public.navy.mil/bupers-npc/boards/activedutyofficer/05staff/Documents/FY-14/FY14%20AO5S%20STATS.pdf

FY15 Promotions - CDR

• Precept: 70% selection of IZ candidates• 159x 0.7 = 111 = max # of selects• 78 (IZ) + 33(AZ) = 111• IM: 66% IZ (10/15) 8 AZ selected

Zone Eligible Selected %

AZ 92 33 36IZ 159 78 49BZ 373 0 0

FY15 O-5 Selection Results

http://www.public.navy.mil/bupers-npc/boards/activedutyofficer/05staff/Documents/FY-15/FY-15%20AO5S%20CONVENING%20ORDER.pdf

FY15 Promotions - CAPT

• “Precept: 60% selection of IZ candidates”• 112 x 0.6 = 67 max # of selects• 53(IZ) + 14(AZ) = 67

• IM: 11/14 IZ 1/10 AZ 0/36 BZ

Zone Eligible Selected %

AZ 138 14 10

IZ 112 53 47

BZ 208 0 0

FY15 O-6 Selection Results

http://www.public.navy.mil/bupers-npc/boards/activedutyofficer/06staff/Pages/default.aspx

PROMOTION BOARDS• Google “BUPERS “

– “about BUPERS – us navy” “boards” “active duty staff officer “ “05 staff”

• Timing of sub-specialty training must be considered for O-5/O-6

• Competitive FITREPs– Breaking out in COMPETETIVE peer group– “rightward progression” while in rank

• Increasing leadership role and positional responsibility!

• Ensure your photo is up to date, in current rank!• Document Board Certification

• Manage your online Officer record, OSR/PSR

• Document accomplishments during FTOS training– Publications, Research Presentations Class rankings

From the OOMC• MilSuite

– One place to organize key data to answer frequent questions or find points of contact

– Reduce reliance on email– More communication between the hospitals – We shouldn’t have to recreate the wheel

2014 Change…2015 uncertainty

• Ebola is an evolving problem

• ISIS -- Syria, Iraq?• How will transition in Afghanistan go?

• 2016 budget: what will it be, and how will it affect us?

• Another year into e MSM’s

• GMO Conversions ??

Unique Opportunities• CAPT Matthew Lim

– BUMED liaison, Global affairs,DHHS

• LCDR Jamie Peterson– BUMED Medical Student

Recruiting/Admin Fellow

• CAPT Utz– Health attache to VietNam

• MBA program – Navy PG School distance learning

program

Billets 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

Billets 2014

• Priority will be given to Staff– Returning from OCONUS, arduous sea duty– Deployment– Rank

• GMESB is next milestone, results released Dec 2014

• Board certification required for MEDCEN billets• Residents will be slated in January

• Specialty leaders are working closely with BUPERS for best fit for each individual, Command and Navy

Deployments

• 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

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 712

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 471Data source: EMPARTS 12 Oct 2014

Deployments 2013

SURGERY

ANESTHESIA

EMERGENCY M

ED

INTERNAL M

ED

FAM

ILY PRACTICE

Ortho

PSYCHIATRY

Neurosu

rgery

OB/GYN

02468

10121416

Total number CURRENTLY deployed by specialty

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 systemData source: EMPARTS 12 Oct 2014

Deployment

• IM has/had habitual relationships for specific IAs– Pacific Partnership– Continuing Promise– EMF Kandahar (pulm/cc)– JTF GTMO (NE-2213)– EMF Djibouti (NE-2089)– Embedded Training Teams (NE-4255)– Forward Surgical Teams (NE-5326, NE-5254)

Deployment Forecast FY15

• Discussion with POMIs, nothing imminent

• Any Surprises in Afghanistan next spring?• Syria, ISIS, Ebola….• Fiscal Climate affecting Humanitarian Missions

• Our Primary Role Is to Support These Deployments. We all must be ready….

Deployments

• For IM, what does it mean to be “operationally ready” (currency)?

• How do we measure that?• What type of training would that require?

• What impact would that have?

IM Deployment Business Rules1. No position is too important to deploy (except CO).2. No one shall be recommended for deployment until everyone has

deployed a first time.3. Total deployed days taken in to account for deployment recommendation4. In order to facilitate consolidation of knowledge and board passage,

recently graduated fellows should be protected from deployment during their first post-GME year.

5. Prior overseas PCS moves will not count towards IAs.6. Deployer order may be modified based upon extenuating circumstances

and the needs of the Navy (i.e. a specific specialty is required or a particular institution is already heavily deployed).

7. Volunteers will always be solicited prior to assigning deployers.8. Volunteering for one assignment, does NOT move you higher on the list

for the next available assignment.9. Chain of Command (and subspecialty SL if applicable) will be engaged

prior to SL recommendation.10. Will avoid by name requests, if possible, to sourcing MTF.

THANK YOU!

• Thank you for your professionalism

• Thank you for your hard work and dedication to our patients

• Thank you for constantly striving to improve Navy Medicine

Points of Contact

• CDR Daniel Seidensticker IM Specialty LeaderDaniel.seidensticker@med.navy.mil

• CDR Joel Schofer DetailerJoel.Schofer@navy.mil

• CAPT Harry Ward Reserve IM SLHarryj.ward@yahoo.com

Thank you for your service!

“Cogito ergo I.M.”

Supplemental slides

Also note, for a general internist each paRVU is worth $46.35 a Navy general internist to generate $88,899 in equivalent production.

2012 MGMA report (below),Navy MGMA 40% targets (right)

Promotion Guidance

• Timing of sub-specialty training must be considered if coming in to zone for O-5/O-6

• Ensure your photo is up to date, in current rank!

• Manage your online Officer record, OSR/PSR

• Document accomplishments during FTOS training– Publications, Research Presentations Class rankings

Professional Guidance

From the OOMC

• FITREPs are written for Promotion Board members

• Expectations– All MC Officers will complete residency – All MC Officers will achieve board certification

• O-6 board looks for demonstrated leadership– Clinical– Academic– Operational– Executive

• Pass PRT/BCA

Professional Guidance

Change is coming to Navy Medicine

• Enhanced Multiservice Markets (eMSM’s)– PUGET Sound, Hampton Roads– National Capital Region– San Antonio, National Capital, Colorado Springs,

Pearl Harbor– NMCSD, Camp Lejeune considered their own mini

markets– CO of that eMSM will have operational control of

all facilities