Navy Update

Consultant’s Report – Spring 2024
Michael J. Arnold, MD, FAAFP
Naval Undersea Medicine Institute
michael.j.arnold4.mil@health.mil

Greetings, Navy Family Medicine colleagues! It was so great to see so many of you at the USAFP Meeting! By the time you read this, I expect that the promotion boards will all be over and we’ll be awaiting results.

DHA IS WORKING TO MAKE THINGS BETTER IN MTFS
LTG Crosland came back to USAFP for the second year in a row as the DHA Director. She remains committed to her vision of using technology to reduce the administrative burdens on provider teams. These changes are being introduced in incubator programs in Jacksonville and San Diego. Interestingly, models that focus on our ability to take care of patients without looking at availability or appointments are coming back. She took many hard questions and freely acknowledged
that her message does not always match some of the messages we are getting from senior leaders who work for her. She let us know that she sees our staffing issues and she is on it.

USAFP NAVY MEDICINE BREAKOUT – RDML (SEL) BROWN
Our USAFP Navy breakout featured the first Navy Family Medicine physician promoted to flag rank in a decade, RDML (sel) Kevin Brown, who currently serves
as commander of Naval Medical Center Camp Lejeune.

Dr. Brown talked about how FM is a critical wartime specialty and the “Swiss Army Knife” that Navy Medicine relies on. During our preparation for the next war, the Navy is going to need Family Medicine physicians who are ready to provide prolonged care in environments with limited resources. He then responded to many questions, a summary of which was sent to the Navy FM distribution email group. If you did not receive this summary, just reach out to me and I’ll resend it.

CONUS MTF STAFFING
As you all know, staffing our MTFs is just getting more challenging. We are officially staffed to 83% of what we are supposed to be at according to how BUMED tracks it. In summary, we are 403 Navy FM physicians, with 84 of us in FM operational billets and 125 of us serving in non-FM tagged billets – Flight, UMO, Exec Med and billets labeled with other specialties. While 194 of us serve in MTF billets, 78 of us are OCONUS and 33 are in residency programs, so there are only 83
of us left to cover all the CONUS MTF billets outside a residency program.

While this pattern is seen throughout the Navy Medical Corps, the size and ubiquity of Family Medicine make the problem more acute. Navy Medicine has long struggled with General Surgeons and Anesthesiologists, but this year the gaps in Family Medicine will eclipse both.

This is the major point I am making to the Corps Chief office, and they recognize the issue. We saw a change in bonuses, and we are working to improve the culture in the MTFs. The Navy does some things great – annual leave, parental leave, and co-location policies. We need to ensure the working environment in
our MTFs matches these policies.

PROMOTIONS – NEVER LOOKING BETTER
There are several reasons that promotions will continue to be better this year:

Staffing – When there are fewer physicians, promotion rates go up and zones come faster. We lost a lot of above-zone folks, so it’s a great time to be in-zone. There are also fewer above zone people compared to previous years. Watch the zones over the next few years – promotion opportunities could come sooner than you think.
Rule Changes – First, any officer getting out of the Navy in the next several months is taken out of the pool for in-zone promotions. We have also been granted the ability to take the LCDR in-zone promotion rate up to 99%.
Promotion Rates – Promotion Rates are as high as they have ever been – 90% for O-5 and 95% for O-6 – although this is the in-zone percentage.
One-of-One Fitreps Valued – One of the traditional issues with operational tours is that the 1-of-1 Fitness Reports common in operational jobs were difficult to compare to the MTF physician with the clear breakouts among peers. The Board Precept letters have been saying that they value operational tours despite 1-of-1 Fitreps, and I’ve seen more and more promotions of primarily operational colleagues. Soft breakouts are essential and line COs tend to be outstanding at this.

In the next issue, I hope to share real promotion data that confirm my optimistic assessment.

BONUSES
You know that I have neither input nor insight into the future bonuses. For the last few years, I have been unapologetic in reminding my bosses of how poorly the FM bonuses have been handled.

We now have the 6-year bonus back and it won’t be going away. RDML Valdes told us that he proposed allowing annual renegotiation of bonuses. This proposal would both allow anyone to renegotiate if bonuses increase and allow anyone to add a year to the longest bonus they feel comfortable taking.

APPRECIATION
Thank you for all your daily actions in service to our patients, our Navy, and our nation. I continue to be honored by the opportunity to provide a voice for our community and advocate for my colleagues. Please reach out to me whenever I can be of help with questions or advice or to connect you with other colleagues who can. Enjoy your summer.

Thanks, Mike

NOTE FROM RDML (SEL) BROWN
Greetings Family Medicine colleagues!

It was great to see so many of my shipmates at USAFP, where it really was like coming home. I appreciated the chance to share the Surgeon General’s North Star for Navy Medicine and his four Lines of Effort as we continue to develop and deliver a Maritime Medical Force to support global competition, crisis, and combat. Thank you for your active engagement during the breakout session—keep the questions coming and lean in to be part of the solution for hard problems.

I am honored by the opportunity to continue to serve with you as I transition to my next role. We have many challenges in the next few years, and I am thrilled to be on your team as we face them together.

Kevin Brown, MD

DETAILER UPDATES
Greetings Navy Family Medicine Community!

I regret that I was not able to make the Annual Meeting in New Orleans. As I write this, I’m still waiting to PCS to Millington to take over as your detailer. I know that CAPTs Frame and Arnold talked to many of you. We will publish my new email address after I check-in.

The 2025 detailing process will begin soon so be on the lookout for key opportunities included in Dr. Arnold’s emails. The BUMED Milestone and Command screening opportunities are published with applications due on 15 June. I encourage senior FM physicians to apply – we need your leadership!

Most of my work will be with Family Medicine and Non-Specialty Specific opportunities. This summer, I will send ranking lists and the non-specialty specific billet opportunities for anyone with a PCS in 2025. In the fall, I will start putting orders in once I have seen everyone’s input for their next duty station although I will wait until late fall for anyone applying to a BUMED Milestone, Command screen or non-specialty specific opportunity.

As we start the 2025 detailing cycle, please remember that operational billets will continue to be the top priority followed by OCONUS and then CONUS duty stations. If you have not been in an operational billet (Fleet or Fleet Marine Forces), I strongly encourage you to look at these opportunities to learn about the Navy you serve in and get a refresh from the Military Treatment Facility. It is extremely important for your leadership and promotion to be able to successfully navigate in both environments.

John Ewing, DO