Navy Update

Navy Consultant Report

James Keck, MD, MBA, FAAFP
Naval Hospital, Jacksonville, FL
jkeck@usna94.com

Greetings, Navy FM! In preparation for this article, I looked back at the newsletter from a year ago and found myself marveling at all that has happened since those early days of the COVID-19 pandemic. I had commented that the coming months would provide opportunities for us to grow as clinicians, educators, and leaders. The interval year has proven my statement to be true as you were called to respond to various challenges in providing care, not just to our traditional beneficiaries, but also in support of our communities in the civilian sector. I appreciate all you have done, especially in the face of all the other changes we are facing. During the recent USAFP Navy Breakout session, I was glad to share with many of you updates on the major issues. In this report, I’ll recap the key items that were discussed.

USAFP ANNUAL MEETING
I would like to start with a word of gratitude towards our academy for their work in hosting a highly successful virtual “live” annual meeting. While we all look forward to the day when we can once again gather in-person, I could not have imagined a better engineered substitute. Bravo Zulu! I think the innovations and successes that were seen in this year’s meeting will only make future conferences that much better. I’m already looking forward to next year’s event. If you are already considering attending, your best bet to get approved is to be accepted as a speaker or research presenter. The deadline to submit is 30 May 2021.

MANNING STATUS
As of 31 March 2021, we had an inventory of 366 uniformed Family Medicine physicians for 411 billets, which includes 37 “Fair Share” billets (positions which are not specifically tagged for a FM doc.) Our community includes 32 Sports Medicine, 8 FM-OB, 7 Faculty Development, 1 Geriatrics, and 1 Adolescent Medicine trained physicians. Our inventory translates to an 89.1% overall fill rate and a gap of 45 billets. These stats are relatively unchanged from this time last year. Our manning will see a downward trend in the coming months as individuals retire or release from active duty at the end of their commitments, no doubt exacerbating the stress of gaps at your commands. We traditionally see a boost in our manning (and thus can eventually backfill a number of the gaps) thanks to our residency graduates who join our ranks each summer. If you are approaching your PRD (or the end of your obligated service) and are wondering about what to do next, please reach out to our detailer to explore options. The goal is to align your professional goals with available opportunities and priorities. I am also available to be of help, so don’t hesitate to reach out to me.

BSO-18 (NAVY) TO BSO-27 (USMC)
Many are starting to hear about another initiative that has been in the works for a couple of years, but is now finally hitting implementation phase. Separate from any other manning actions (e.g. MEDMACRE, GMO conversions, POM-20), the USMC has bought a number of medical corps billets (not just FM) to augment their operational medical support. These billets will be attached to USMC operational units (e.g. Med BN’s), with phased detailing beginning as early as later this year (2021). FM has 17 of these new billets, which are located at: Camp Lejeune (4), Camp Pendleton (6), Okinawa (1), Pearl Harbor (3), and NMC Portsmouth (3).

DETAILING
Our detailer, CDR Tara O’Connell, continues to work hard to match every member of our community with a position that aligns their professional goals with available billets and in a way that also meets the needs of the Navy. We are both very grateful for all the patience shown by officers who are in line to execute orders this coming summer. Timelines were pushed to the right for detailing more senior positions throughout Navy Medicine (e.g. CO/XO, CMO, OIC, non-specialty specific billets), which had a downstream impact for detailing our community. Additionally, billets targeted by POM (divestitures/cuts) in FY21-24 were pulled from the list of billets to be detailed, changing the options available.

Looking forward, if you are slated to PCS in the summer of 2022, please put on your “to-do” list contacting CDR O’Connell 12 months out from your PRD. As with every detailing cycle, do know that the “must-fills” are operational and OCONUS positions. The most recent promotion guidance is emphasizing more than ever the importance of doing an operational medicine officer (OMO) tour as well as highlighting the diversity of geographic assignments. I encourage you to discuss with the detailer when best to rotate to one of these billets relative to your promotion timeline. CDR O’Connell can be contacted at PERS via her email tara.oconnell@navy.mil or by phone: (901) 874-4037.

POM/DIVESTITURES
Since I mentioned the divestitures, let me jump into an update. The possibility of divestitures (cuts) in billets across all services medical departments continues to loom over the military health system. While these billet reductions were put on hold by Congress until a review of the medical manpower requirements under all national defense strategy scenarios has been completed, various actions have been taken to move us in the direction of a reduced end-strength. Reduced retention bonuses (see below) and detailing changes (previously mentioned) are two of the more visible impacts. What is clear is that uncertainty will remain until Congress makes a final determination. To share with you a snapshot of the projected manning impacts, FM is slated to lose 90 billets by FY24, which is a reduction in our community of 24% (not including Fair Share billets.) If our personnel inventory stays at current levels, our manning will jump to 114% (historical note: FM has not been 100% manned since 2002.) These cuts are almost all coming from CONUS clinical billets. As a result, we’ll see the proportion of our operational + OCONUS footprint increase from 42% to 55% of our billets. (This does not include any operational billets FM will receive as a result of future GMO conversions.) While FM is forecasted to lose the most billets, other specialties will see a greater percentage of their communities reduced (for example: Derm -62%, Ophth -50%, ENT -49%, OBGYN -48%, Neurology -48%, Peds -42%, Uro -35%, IM -32%.)

SPECIAL PAYS
We had hoped that FY21 would see a rebound in our Special Pays Plan. Unfortunately, the uncertainty created by the divestitures has resulted in FM retention bonuses (RB) going unchanged from FY20. As a review: compared to FY19, only 2 and 3 years contracts are available (no 4 year and 6 year contracts), and there is a restriction in renegotiating new contracts. The RB for the remaining contracts are $2k less than FY19 ($15k vs $17k for the 2 year term; $23K vs $25k for the 3 year term.) Since special pays are a retention tool, it is not surprising that reduced RB’s have impacted not just Family Medicine, but a number of other communities. And while we remain undermanned, this is not the case in a post-divestiture end-strength scenario. It is my perspective (OPINION) that as long as the possibility of divestiture implementation remains, it will play a part in subsequent RB decisions. Leadership does recognize the value FM brings to the operational mission, as was stated by the SG in our breakout session. Your response on the frontlines of the COVID-19 response serves as an example of your versatility and mission impact, and I will continue to share this perspective at every opportunity. I am glad to talk with anyone who has questions, or facing a difficult career decision as a result.

KSA’S UPDATE
Implementation of KSA’s continues to move forward. As a review, on 14 July 2020, the SG signed a package of 41 Naval Medical Readiness Criteria (NMRC), with a plan that will eventually see 139 checklists developed. These NMRC’s are more commonly known as KSA’s, which are the “Knowledge, Skills, and Abilities” that Naval personnel are supposed to possess in order to do their jobs well. Navy Medicine has been working to define and standardize the KSA’s for medical personnel, with an operational-readiness focus. They are broken into 3 categories:

1) Core Practice / Clinical Currency

2) Expeditionary Skills for readiness / Readiness Currency

3) Platform Training for Readiness.

These were developed in collaboration with senior FM leaders, as well as those of our sister services (reflecting a joint effort.)

To help with the implementation effort, the Naval Medical Force Development Center (NMFDC), a part of BUMED, is developing dashboards (“Navy Proficiency Dashboard”) to easily allow commands and individuals to see where they stand on their KSA’s. The dashboard is a work in progress but is emerging as a primary tool for tracking these metrics. Going forward, it will be the Navy Medicine Readiness and Training Commands/Units (NMRTC/U’s) that will be responsible for getting their personnel ready and meeting their KSA’s. At this point, commands should be taking a look at their KSA’s and performing a gap analysis. It should be the goal to get as many KSA’s as possible within your 4 walls, and then explore partnerships to resource the remaining needs. This may include connecting with a local MTF, partnering with a local VA or civilian facility, or arranging for TAD.

It should be noted that KSA’s are a work in progress and will continued to be reviewed, validated, and amended as needed. Thus, I invite your feedback as we move into the implementation process. For another summary, go to: https://mccareer.org/2020/08/24/whatare-ksas/

GMO CONVERSION
A proposal has been drafted for the conversion of GMO, Flight Surgery, and Undersea Medicine Officer billets, in which these positions will be filled by residency trained physicians. This would align the Navy with the model used by our sister services. Additionally, an increasing number of states are requiring 2 years of GME for medical licensing, which will eventually make this transition necessary. Finally, medical students desire straight-thru training. This initiative would impact approximately 415 GMO, FS, and UMO billets. It would involve a gradual transition over 5 years to residency trained Operational Medical Officers (OMO’s), timed with a gradual increase in straight-thru GME training opportunities. The OMO’s would be mainly primary care, but no decision have been made on which specialties will get which OMO billets. However, it is anticipated that FM will get proportionally less than the other primary care specialties given our comparatively larger operational footprint.

MILESTONE (CMO, OIC), CO/XO OPPORTUNITIES & APPLICATION PROCEDURES
As I was typing this column, the notice for milestone (CMO, OIC) opportunities was released, and it is anticipated that CO/XO Opportunities and Application Procedures will be available by the time your eyes read this page. Check out the Office of the Corps Chief website for more info.

DHA TRANSITION UPDATE
Amid the COVID-19 pandemic response, the DHA transition has been paused. Since my last update…its back on. Guidance was provided by both the Secretary of Defense and the Assistant Secretary of Defense for Health Affairs on 09 November 2020 to resume the transition of MTF administration and management from the Military Departments (MILDEPs) to the DHA in support of the implementation plan. The secretary charged DHA with 3 priorities:

1) ensuring the delivery of high-quality healthcare,

2) utilize the MTF’s as much as possible for readiness workload, and

3) ensuring the medical readiness of the force.

More details can be found in the memorandum from the SECDEF at: https://www.milsuite.mil/book/docs/DOC-901303.

[As a review, the Military Health System (MHS) consists of 51 military hospitals, 424 clinics, and 248 dental clinics, serving 9.5 million services members, military retirees, and their families. In 2013, the SECDEF directed the establishment of the DHA as part of the DoD’s effort to reform the DHS. Section 702 of NDAA 2017 directed the DHA to assume authority, direction, and control of all MTFs by 01 Oct 2018. This date was amended to NLT 30 September 2021 by NDAA 2019. The transition began on 01 Oct 2018 with 31 CONUS MTF’s being redesignated under DHA administration and management. The following year in Oct 2019, DHA assumed responsibility of all MTFs within CONUS, Hawaii, and Puerto Rico, with a plan to transition the remaining MTFs using a phased, conditions-based approach. DHA is in the process of establishing 21 Market Offices. Because of the COVID-19 pandemic, the Deputy SECDEF approved a pause in transition activities to focus on COVID-19 response efforts. On 05 August 2020, the Secretaries of the Army, Navy, and Air Force, along with the the Chief of Staff of the Army, CNO, Chief of Staff of the Air Force, Commandant of the Marine Corps, and the Chief of Space Operations, called for the return of all military hospitals and clinics already transferred to the DHA and suspension of any planned moves of personnel or resources. On 03 September 2020, the Deputy SECDEF noted that the MHS reform was directed in law, and planned to better understand the concerns of the services. The 09 November 2020 memo referenced above resumed the transition.]

NEW PROGRAM DIRECTOR AT NAVAL HOSPITAL JACKSONVILLE, FL
I am pleased to share with you that CDR Dustin Smith has been appointed as the newest Family Medicine Program Director of the FM residency program at NH Jacksonville. He follows in the shoes of CAPT Kris Sanchack, who completed 5 years at the helm providing outstanding leadership during a time of extraordinary change and challenges. CAPT Sanchack leaves behind an award winning program that recently hit the 50 year milestone since opening its door. His leadership of a team that provided outstanding training and mentorship will continue to positively impact all those we serve. We are grateful for his commitment and service and wish him fair winds and following seas! And congratulations and best of success to CDR Smith!

NEXT FAMILY MEDICINE SPECIALTY LEADER
Later this year, I will be turning over as your Specialty Leader. On April 1, I sent out an email with the official announcement for interested candidates to submit applications, and it was also posted on the Medical Corps Chief website. The goal is for the next individual to be identified in time to participate in the next GME cycle with turnover at the GME Selection Board in November 2021.

COMMUNICATION
As has been my habit, I am going to continue to list the below venues as a means for us to stay connected as a community, corps, and service:

  • Office of the Corps Chief Website: https://esportal.med.navy.mil/bumed/m00/m00c/M00C1/
  • mil (https://www.milsuite.mil): Search: “Navy Family Medicine”.
  • Email: I send out periodic announcements to the community. If you haven’t heard from you, then I probably do not have you in my email group. Send me an email at james.w.keck.mil@mail.mil, and I will get you added. Family Medicine leaders at local commands, I ask you to please check with your FP’s to see if they are getting my emails to ensure they are in the loop.

This article is one of my lengthier contributions, and speaks to the reality of all the issues with which you wrestle every day. I am grateful to be serving with you and consider it a privilege to be a voice for our community. Please don’t hesitate to reach out to me with any questions or concerns.

Stay well