MEDCOM Updates

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MEDCOM Updates

Christopher A. Dillon MD

COL, MC

Accessions/Recruiting Liaison to OTSG

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Current Issues in Medical Education

• Increase in Medical School Enrollment

AAMC reports nearly 30% from 2002

80% of MD schools

75% initiatives encouraging primary care

• 112th Congress Deficit Reduction

60% reduction ($3.9B) in Medicare payments to teaching hospitals

ACGME concerned re: # trainees & education

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• Control Act of 2011

Eliminates interest subsidies on Stafford Loans

– Graduate & Professional Students begin July 1, 2012

– Still have access to same amount of loans ($40,500 for medical students)

– Since unsubsidized, estimates increase loan costs by $10,000-$20,000 per student

• Physician Salaries https://www.aamc.org/download/48732/data/compensation.pdf

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• National Match 2014- MD applicants will equal positions offered

– GME slots up 6%/5 yrs but applicants up 9.5%/5 yrs

– Only 52% of civilians got 1st choice

14,000 non-U.S. senior applicants

Match will be more competitive (>900 U.S. senior medical students didn’t match last year)

• Military Match Smaller, better chance to match 1st or 2nd

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GRADUATE MEDICAL EDUCATION STATS

• Number, specialty distribution, subspecialty options programmed to meet the needs of the Army.- 137 Programs 72 residencies, 59 fellowships, 6 transitional internships).

- 22 Specialties. - 11 Teaching hospitals. - 57% of programs with 5 yr. accreditation; 20% with 4 yr. accreditation (3.95 yr is civilian average; Army average 4.3 yrs).

• Majority of Army physicians in GME train in in-house programs. - 1466 in training (1355 in-house programs and 111 Army sponsored civilian training). 30 in educational delay/FAP.

- Comprises 31% of active duty Medical Corps end strength.

• 93% first time board pass rate.

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Army GME Success Stories

• Brooke AMC and Walter Reed AMC General Surgery Two of only 10 surgery programs in the country (250 programs total)

to have a 100% first time pass rate on both written and oral boards over the last 5 years

• Emergency Medicine Residents at Darnall ACH, Brooke AMC and Madigan AMC have

scored in the top 10 nationwide on the annual EM in-service exam for the past 11 years

• Internal Medicine WRAMC IM residents (13) achieved a 100% pass rate on the 2007

ABIM certification exam. The national average for first-time takers between 2002 and 2006 is 91%. The Walter Reed average for first-time takers for the past 10 years is 98%.

• Ophthalmology The Army had the first residency program in the US to get the virtual

reality ophthalmic surgical simulator. 100% of our ophthalmology residency programs are sim-inclusive.

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Medical Research

• The U.S. Army Aeromedical Research Laboratory (USAARL), Fort Rucker, Alabama

• U.S. Army Institute of Surgical Research (USAISR), Fort Sam Houston, Texas

• U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen Proving Ground, Maryland

• U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland

• U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts

• Walter Reed Army Institute of Research (WRAIR), Forest Glen, Maryland U.S. Army Dental Research Detachment

U.S. Army Medical Research Detachment

Armed Forces Research Institute of Medical Sciences-Thailand (AFRIMS)

U.S Army Medical Research Unit- Europe

U.S Army Medical Research Unit- Kenya

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Regional Medical CommandsTeaching Hospitals

Walter Reed AMC Womack AMC DeWitt ACH Keller ACH (West Point)Eisenhower AMC Martin ACH Darnall AMC Brooke AMCWilliam Beaumont AMC Madigan AMC Tripler AMC

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SPECIALTY SAUSHEC EAMC MAMC TAMC NCC WBAMC WAMC DARNALL MARTIN VA-DoDEmergency Medicine X X X XFamily Medicine X X X X X X XGeneral Surgery X X X X X XGS Neurosurgery X XGS Urology X X X X XInternal Medicine X X X X X XNeurology X XChild Neurology XOB-GYN X X X XOrthopaedics X X X X X XOtolaryngology X X X XPathology X X XPediatrics X X X XPsychiatry X XPsychiatry/Internal Medicine XTransitional X X X X XPrelim Aerospace Medicine XPrelim Anesthesiology X X X X X XPrelim Dermatology X X X XPrelim Ophthalmology X X X X X XPrelim Physical Medicine X XPrelim Preventive Medicine X XPrelim Radiation Oncology XPrelim Radiology(DIAG) X X X X X

SAUSHEC –Brooke Army Medical Center, Fort Sam Houston, TX/Wilford Hall Medical Center, Lackland AFB, TX/University of Texas, San Antonio, TXNCC –Walter Reed Army Medical Center, Washington, DC/DeWitt Army Community Hospital, Fort Belvoir, VANational Naval Medical Center, Bethesda, MD/Malcolm Grow Medical Center, Andrews AFB, MD/USUHS

ARMY FIRST YEAR GRADUATE MEDICAL EDUCATION (FYGME) PROGRAMS - (PGY-1)

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Residencies

• Internal Medicine

• Family Medicine

• Emergency Medicine

• Pediatrics

• Obstetrics/Gynecology

• General Surgery*

• Neurosurgery

• Orthopaedics

• Urology

• Otolaryngology

• Preventive Medicine/ Occupational Medicine*

• Dermatology

• Radiology

• Radiation Oncology

• Anesthesiology

• Aerospace Medicine*

• Neurology and Child Neuro

• Pathology

• Psychiatry

• Physical Medicine and Rehabilitation

• Ophthalmology

* Specialty does not offer continuous contract; must reapply for PGY-2 year.

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PGY-1 Categorical Specialties

• Emergency Medicine

• Family Medicine

• General Surgery

• Internal Medicine

• Neurology

• Neurosurgery

• OB-GYN

• Orthopaedics

• Otolaryngology

• Pathology

• Pediatrics

• Psychiatry

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Designated Preliminary/Pre-Select Specialties

• General Surgery* o Urology

• Transitional Year Undesignated

Designatedo Aerospace Medicine*

o Anesthesiology

o Dermatology

o Ophthalmology

o Physical Medicine

o Preventive Medicine/Occupational Medicine*

o Radiation Oncology

o Radiology (Diagnostic)

* Specialty does not offer continuous contract; must reapply for PGY-2 year.

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Applications For FYGMEApplicants Per Approved Positions

SPECIALTY (#slots 2011) 2006 2007 2008 2009 2010 2011

Emergency Medicine (28) 1.25 1.23 1.63 1.15 1.14 1.36

Family Medicine (44) 1.09 0.80 0.58 0.56 0.88 1.07

General Surgery (26) 1.29 1.10 0.92 1.65 1.84 1.65

GS Neurosurgery (3) 0.50 1.00 1.00 7.00 1.50 1.33

GS Urology (7) 1.57 1.00 1.17 1.57 0.57 0.71

Internal Medicine (58) 0.84 1.06 0.75 0.65 0.71 0.66

Neurology (6) 1.20 0.60 0.33 1.20 0.50 0.83

Child Neurology (1) 0.00 0.00 0.00 0.00 0.00 1.00

OB-GYN (17) 1.53 1.13 1.20 1.20 0.59 0.83

Orthopaedics (19) 1.36 1.95 1.84 1.47 0.89 1.21

Otolaryngology (7) 1.28 4.00 1.14 1.00 1.71 1.33

Pathology (6) 1.16 0.50 1.17 1.00 1.00 1.17

Pediatrics (26) 1.20 0.88 0.92 0.62 0.62 0.92

Psychiatry (15) 0.83 1.07 0.64 0.71 0.87 0.88

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Applications For FYGME (continued)Applicants Per Approved Positions

SPECIALTY (#slots 2011) 2006 2007 2008 2009 2010 2011

Psychiatry/Internal Medicine (0) 0.50 1.50 0.50 1.50 2.00 0.00

Transitional (15) 0.27 0.06 0.20 0.13 0.13 0.13

Prelim Aerospace Medicine (1) 0.50 0.50 0.00 0.00 1.00 0.00

Prelim Anesthesiology (12) 1.33 1.42 1.25 1.50 0.83 1.25

Prelim Dermatology (7) 1.62 1.29 0.57 1.29 1.29 0.71

Prelim Ophthalmology (7) 1.42 1.14 0.72 1.57 0.86 0.43

Prelim Physical Medicine (3) 1.66 2.00 3.33 1.00 1.33 2.00

Prelim Preventive Medicine (2) 0.25 0.67 0.75 0.50 0.50 1.00

Prelim Radiation Oncology (1) 2.00 0.00 2.00 1.00 0.00 1.00

Prelim Radiology (Diag) (15) 1.25 1.00 1.67 1.00 0.87 0.87

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VA-DoD Training Opportunities

• Intern year in Army program

• Remainder of residency in VA-sponsored program

Radiology – Medical College of Georgia; UT San Antonio

Urology – UT San Antonio; Duke University

Neurosurgery* – University of Florida; UT San Antonio

*Entirety of training in VA-sponsored program

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2010 Army GMESB Selection Summary Report Fellowship Training

Selects

Inservice

Military

Selects

Deferred

Selects

Civilian

Sponsored

Total

Selects

Non-

Selects

Total

Applicants

Inservice

Select

Rate

Overall

Select

Rate

Utilization/

Field46 0 26 72 23 95 48% 76%

Interns 0 0 0 0 0 0 0% 0%

Current

Deferred1 0 0 1 6 7 14% 14%

Current

Residents30 0 29 59 57 116 26% 51%

Civilian 1 0 0 1 2 3 33% 33%

Totals 78 0 55 133 88 221 35% 60%

Female 19 0 10 29 22 51 37% 57%

Minorities 21 0 12 33 26 59 36% 56%

Totals 40 0 22 62 48 110 36% 56%

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Fellowships 2012

Aerospace Med Hyperbaric Med CIV 1

Anesthesiology Acute Pain/Regional Anesth NCC 1

Critical Care Anesth NCC 1

Pain Management NCC 2

Pediatric Anesth CIV 1

Dermatology Dermatologic Surgery CIV 1

Emergency Med Wilderness Med MAMC 1

Emergency Med Cardiology CIV 1

Emergency Med Services SAUSHEC 1

Emergency Toxicology CIV 1

Pediatric Emergency Med CIV 1

Sports Med CIV 1

Ultrasound SAUSHEC/MAMC/Darnell 3

Family Medicine Faculty Development MAMC 3

GI/Colonoscopy MAMC 1

Hospitalist CIV 1

OB/GYN Darnall/CIV 2

Sports Med NCC/CIV 3

General Surgery Plastic Surgery CIV 2

Other Surgery Advanced Laproscopy CIV 3

Trauma/Critical Care Surgery SAUSHEC/CIV 2

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Fellowships 2012

Internal Medicine Cardiology SAUSHEC(2)/NCC(3) 5

Cards Interventional CIV 1

Critical Care Med SAUSHEC 1

Endocrinology NCC 1

Gastroenterology SAUSHEC(3)/NCC(2) 5

GI Invasive Endoscopy CIV 1

General Internal Med WBAMC 1

Hematology/Oncology SAUSHEC(1)/NCC(2) 3

Infectious Diseases SAUSHEC(2)/NCC(1) 3

Nephrology NCC 1

Pulmonary/CCM SAUSHEC(1)/NCC(2) 3

Rheumatology NCC 1

Neurology Child Neurology NCC 1

Clinical Neurophysiology NCC 1

Headache Medicine CIV 1

Neuro Critical Care CIV 1

OB/GYN Maternal and Fetal Medicine MAMC/CIV 2

Gyn Minimally Invasive Surgery NCC 1

Reproductive Endocrinology NCC/CIV 2

Ophthalmology Glaucoma CIV 1

Ophthalmic Pathology CIV 1

Retinal Surgery CIV 2

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Fellowships 2012

Orthopedics Childrens Ortho CIV 1

Feagin Sports Med Keller 2

Hand Surgery NCC 2

Orthopedic Trauma CIV 2

Shoulder Surgery CIV 1

Spine Surgery CIV 2

Total Joint/Recnstructive Surg CIV 1

Otolaryngology Facial/Plastic/Reconstruct Surg CIV 1

Head and Neck Surgery CIV 2

Pediatric Otolaryngology CIV 1

Sleep Med and Surgery CIV 1

Pathology Clinical Molecular Genetics CIV 1

Forensic Pathology AFIP 1

Neuro Pathology CIV 1

Pathology Infomatics CIV 1

Pediatrics Developmental Peds MAMC 2

Neonatology SAUSHEC(1)/NCC(1) 2

Pediatric Cardiology CIV 1

Pediatric Endocrinology NCC(1)/CIV(1) 2

Pediatric Gastroenterology NCC 1

Pediatric Infectious Diseases NCC 1

Pediatric Pulmonary CIV 1

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Fellowships 2012

Physical Medicine Pain Management NCC 2

Prevent/Public Health Medical Toxicology CIV 1

Occupational Medicine NCC 2

Preventive Medicine NCC 1

Psychiatry Addiction Psychiatry TAMC 1

Child/Adolescent Psych TAMC(3)/NCC(3) 6

Forensic Psychiatry NCC 1

Preventive Psychiatry NCC 1

Psychosomatic/Geriatric Psych NCC 1

Radiology Musculoskeletal Imaging CIV 3

Neuroradiology CIV 1

Trauma Radiology SAUSHEC 1

Vascular/Interventional Rad CIV 1

Urology Stone/Laproscopy Disease CIV 1

Trauma/Reconstructive Uro CIV 1

Specialty Immaterial Adolescent Medicine SAUSHEC 1

Allergy NCC 3

Clinical Pharmacology WRAIR 2

Clinical Research SAUSHEC 2

Critical Care Ultrasound SAUSHEC 1

Geriatric Medicine MAMC 2

Medical Genetics CIV 1

Nuclear Medicine NCC 2

Sleep Disorders SAUSHEC(3)/NCC(2) 5

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Fellowships 2012

Degree Programs Epidemiology USUHS 1

Medical Information Systems MAMC 1

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Leadership Develop. Health Care Admin CIV 2

Health Care Admin-Baylor CIV 2

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HPSP

• 80% of all active duty physicians

• Full assistance (tuition, books, equipment and monthly stipend of $2,088)

• Available to: physicians, dentists, veterinarians, clinical psychologists, pharmacists and optometrists

• Reasons to take scholarship

Debt free after med school (avg. debt is $160,000)

GME opportunities and subspecialty training

Unlimited practice opportunites in

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Reasons to Apply for HPSP

• Debt free after Medical school+ $20k bonus

Median education debt is $160,000

• Outstanding GME opportunities in Army programs and subspecialty training

• Unlimited practice opportunities in academic, operational, clinical medicine and research

• Excellent benefits while on AD and retirement*

• Selfless service

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HPSPHPSP MODEL

Scholarship Length

YEAR OUTPUT 1 YR 2 YR 3 YR 4 YR MAX

11 12 13 14 15

10 0 30 255 INPUT 295

2010 232 283 324 300 255 TOTAL 1162

5 0 30 255 INPUT 290

2011 283 329 300 285 255 TOTAL 1169

0 0 20 255 INPUT 275

2012 329 300 285 275 255 TOTAL 1115

0 0 20 255 INPUT 275

2013 300 285 275 275 255 TOTAL 1090

0 0 20 255 INPUT 275

2014 285 275 275 275 255 TOTAL 1080

0 0 20 255 INPUT 275

2015 275 275 275 275 255 TOTAL 1080

0 0 20 255 INPUT 275

2016 275 275 275 275 255 TOTAL 1080

0 0 20 255 INPUT 275

2017 275 275 275 275 255 TOTAL 1080

0 0 20 255 INPUT 275

2018 275 275 275 275 255 TOTAL 1080

0 0 20 255 INPUT 275

2019 275 275 275 275 255 TOTAL 1080

0 0 20 255 INPUT 275

2020 275 275 275 275 255 TOTAL 1080

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HPSP Changes

• MAC (Minimal Acceptance Criteria):

GPA >/= 3.2 undergrad

MCATs >/= 24 with no score <8

• AAC (Automatic Acceptance Criteria):

NO LONGER

• Average MCAT for HPSP matriculants is 29.3 and average GPA is 3.62

• Waivers: 103 requests, 19 approved

Virtually all approved were for combined programs

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More HPSP Notes

• Residency Competition for Army will peak in 2012-2013

• Most scholarships are 4 years

3-year scholarships mostly rollovers

• HPSP students expected to take BOLC after 1st year medical school

2nd year prepare for part 1 of boards

3rd and 4th years to ADT at Army hospitals

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HPSP Plan of Attack

• New Approach

USAREC and MEDCOM working together

Adjustments in requirements

Improvement in Quality

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Attrition Rates

Year Overall Academic

2007 5.4% 1.7%

2008 4.6% 3.3%

2009 6.4% 4.7%

2010 4.0% 3.1%

2011 3.2% 1.2%

National 4.0% 1.4%

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HPSP Plan

• Target:

Undergraduate universities

Universities with large number of medical school matriculants

Universities with large number of matriculants to out-of-state and private medical schools

Pre-health clubs, Medical Honor societies, advisors & ROTC

Target financial aid advisors at medical schools and staff with access to accepted students

• Provide SME at all events involving at least major universities (Top 65)

• Provide regular training to recruiters from GME and deliver readily available POC

• Provide visibility to leaders and AARs

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STATE University Location Top MD Top DO

Afr. Am. Hispanic Asian

AL Oakwood College Huntsville

AZ U. of Arizona Tucson

Arizona State U. Tempe

CA UCLA Los Angeles

UC Berkeley Berkeley

UC San Diego La Jolla

UC Irvine Irvine

UC Davis Davis

Stanford Stanford

U. of Southern Calif. Los Angeles

CO U. of Colorado Boulder Boulder

CT Yale New Haven

DC Howard U. Wash DC

FL U. of Florida Gainesville

U. of Miami Coral Gables

u. OF South Florida Tampa

Florida State U. Tallahassee

U. of Central Florida Orlando

Florida International U. Miami

GA U. of Georgia Athens

Emory U. Atlanta

Spelman College Atlanta

Morehouse College Atlanta X

Georgia State U. Atlanta X

IL U. of Illinois Champaign Champaign

LEGEND Top 10 Next 11-20 Next 21-30 Next 31-40 Next 41-47

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Northwestern U. Evanston

U. of Illinois Chicago Chicago

Loyola U Chicago Chicago

IN U. of Notre Dame Notre Dame LEGEND

Indiana U. Bloomington Top 10

Next 11-20

LA Louisana State U. Baton Rouge Next 21-30

Xavier U. New Orleans Next 31-40

Next 41-47

MA Harvard U. Cambridge

Boston U. Boston

MD Johns Hopkins U. Baltimore

U. of Maryland College Park College Park

MI U. of Michigan Ann Arbor Ann Arbor

Michigan State U. Lansing

MN U. of Minnesota Mineapolis

MO Washington U. St. Louis

NC Duke U. Durham

U. of North Carolina Chapel Hill

NJ Rutgers U. New Brunswick

NM U. of New Mexico Albuquerque

NY Cornell U. Ithaca

New York U. New York

Columbia U. New York

Stony Brook U. Stony Brook

STATE University Location Top MD Top DOAfr. Am. Hispanic Asian

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STATE University Location Top MD Top DOAfr. Am. Hispanic Asian

OH Ohio State U. Columbus

OK U. of Oklahoma Norman

PA Penn State U. University Park

U. of Penn Philadelphia

RI Brown U. Providence

TN Vanderbilt U. Nashville

TX U. of Texas Austin Austin

Baylor U. Waco

U. of Texas Pan American Edinburg

Texas A&M College Station

U. of Texas San Antonio San Antonio

UT BYU Provo

VA U. of Virginia Charlottesville

Hampton U. Hampton

Virginia Polytech Blacksburg

WA U. of Washington Seattle

WI U. of Wisconsin Madison Madison

PR U. of Puerto Rico-Rio Pedras Rio Pedras

U. of Puerto Rico-Mayaguez Mayaguez

Can. U. of Toronto Toronto

LEGEND Top 10 Next 11-20 Next 21-30 Next 31-40 Next 41-47

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Medical Professional Career Tracks

• Clinical

• Academic

• Research

•Operational

•Multiple Levels of Hooah!

•Command – Leadership

•Corporate Level Management

Arm

y U

niq

ue

Same for Civilian

and Army**

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• Integration of Professional Medical Education and Professional Military Education as the three pillars of leader development:

-Military training/GME

-Self development

-Operational assignments

• Designed to provide guidelines for completion of courses, career integration at specific ranks and career points

• http://www.army.mil/usapa/epubs/xml_pubs/p600_4/head.xml

Life Cycle Model Is:

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FYGME RESIDENCY FELLOWSHIP

Successful Completion of Internship and ResidencyUtilization TourClinician

BN/BDE/DIVSurgeonMEDCOM StaffDCCSMEDCEN StaffMEDDAC StaffResidency DirectorProduct Line MgrDivision ChiefClinician

Corps/MACOM SurgeonCommanderJoint AssignmentsDCCSMECEN StaffDeputy ChiefDir Med EdUSUHS FacultyDepartment ChairResearch Area Dir.

COL LTCMAJCPT

YEARS 0 6 12 30

Rank

Professional Military Education

Additional Training

Self Development

DEVELOPMENTAL & UTILIZATION ASSIGNMENTS

CBRNE SHORT COURSES

Continuing Medical Education / Board Recertification

Typical Assignments

License by yr. 2 Board Certification Subspecialty Board Certification

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MPH MBA TWI ADVANCED SCIENCE DEGREE

ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT

Successful Completion of FellowshipTOE/TDA PhysicianCompany CommanderClinic OICTeaching StaffResearch AssistantClinician

BOLC CCC INTERMEDIATE LEVEL ED SENIOR SVC. COLLEGE

EXECUTIVE SKILLS COURSE

Medical Corps Officer Career Progression

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• An Army Officer

• Training and mentoring junior soldiers/physicians in your specialty.

• Opportunities to lead sooner than civilian practices

• Your professional recommendations are more valued, and you have the autonomy within your practice without third-party interference

• Full-spectrum of leadership opportunities from service/department chief to Surgeon General

Leadership Opportunities

The “Right” Career?

• 4300 career “rabbit paths”• Clinical competence is paramount• Meet the requirements• Stack the deck in your chosen path

– Assignments– Schools– “A” designator– OER Support Forms

• Understand the consequences and accept responsibility

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Retention

• MC Retention Issues Deployment / Family

Length of deployment – Down to 4.5 months for physicians

AHLTA/admin issues

• Initial ADSO Retention FY11=70% FY10 = 63%

FY09 = 59%

57% - 65% over the past 5 years

• Continuation rate beyond initial ADSO > 90%

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OEF/OIF: Rapid Integration of Lessons Learned

• Force Health Protection

Behavioral Health

– Interventions to Enhance Psychological Resilience and Prevent Psychiatric Casualties.

– Pentagon Post-Disaster Health Assessment

– PTSD

Immunizations

– Vaccine Healthcare Centers Network (VHC)

– Myocarditis and Oral Vaccine with Smallpox Vaccine

• Battlefield Medicine

Training of Medics: 91W

Use of Blood Transfusions, Whole Blood, Factor VII

Hemostasis: Tourniquets and HemCon Bandages

Pain Control & Regional Anesthesia: pain pumps

• Home Station/Garrison Care

Amputee Care & Rehabilitation: Intrepid Center

Deployment Health Practice Guideline

Community Based Warrior Transition Unit: CBWTU

Traumatic Brain Injury (TBI)

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Battlefield Survival

• Forward surgical/resuscitation capabilities

• Advanced evacuation capabilities

• Body Armor

• Advanced surgical techniques

• Advances in antibiotic tx

4141

70.7

78.2 76

87.193

0

10

20

30

40

50

60

70

80

90

100

WW II Korea Vietnam OEF OIF

Survivability (%)

Survivability = 100% - (KIA% + DOW%)

WWII

ODS

SOMALIA

OEF

OIF

Transforming for Success

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Army Medicine

Serving the nation since 1775

China 1944 44th MASH, Korea 1954

Radiology residents 1968

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The Army’s Home for Health…Saving Lives and Fostering Healthy and Resilient People

~ Partnerships Built on Trust

Documents

MEDCOM Updates