Medical Corps Billets Being Reduced

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For those of us who are currently in GME or beyond: what are you guys hearing these days about future billet/manning levels?

For Navy I have heard from reliable sources to expect about a 30% reduction in billets over the next five years for my specialty. From other specialties I have heard about the numbers have ranged from 30-40+% cuts. These are apparently coming from a medical manning program.

Are the Army and Air Force folks hearing a similar story?

Granted things ebb and flow but this is a pretty quick and drastic change to manning levels of it is actually implemented over 5 years. That's 2-3 active duty billets a year for the smaller specialties and maybe 8-10 for the larger ones. It was put in a way that made it seem the billets would essentially be converted to civilian positions, so the total manning would be similar, just a much smaller AD population.

Interested to hear what y'all are hearing. Can't imagine this will help retention given the additional impact of abysmal in zone promotion rates to O5 and O6 as of late.


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Is promotion still that bad? I thought it turned a corner?

In zone promotion to CDR was 39.9% this year. With their fuzzy math it was 70%, but that includes 3 below zone and a bit shy of half the selections being from the above zone group.


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at least for my neck of the woods (peds subspecialties), we're barely able to properly staff our departments as it is. I'm not sure where the cuts would come from-- converting primary care slots into civilians? eliminate the "operational tax" of filing BDE surgeon slots? I don't see much fat left to trim.

last year's NDAA had some pretty damning GME related stuff in it if I recall-- none of which was implemented. is that the source of the newest suspected purge?

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Is promotion still that bad? I thought it turned a corner?
Not to put too fine a point on it, but the Navy O5 board was a bloodbath this year. Some of the worst specialties this year:

27% in zone selection rate for anesthesia (3 of 11).

2 of 14 for surgery.
2 of 7 for ortho.
5 of 15 for FP.
6 of 13 for rads.

40% overall all specialties.

It's something to behold.
 
Not to put too fine a point on it, but the Navy O5 board was a bloodbath this year. Some of the worst specialties this year:

27% in zone selection rate for anesthesia (3 of 11).

2 of 14 for surgery.
2 of 7 for ortho.
5 of 15 for FP.
6 of 13 for rads.

40% overall all specialties.

It's something to behold.

Yeah, those are brutal. I wish I had a better idea what to make of it, but those are all pretty large specialties where the "younger folk" are probably getting left out cold when it comes to higher level departmental jobs within the commands by the O5's who are trying to make O6. I know for O6 I think radiology had a near 100% select rate to O6 (if memory serves me).

As to the NDAA question: I'm not sure if it's that directly or more the beginning of the DHA takeover. I think the GME portion is still to be fully realized, but there was certainly some significant background work going on trying to quantify the number of people involved and the cost associated with GME over the last year. From what I have heard the Services are planning on justifying all GME based on the need to support the higher profile programs. For example, you can't have a general surgery program if you don't have Pediatric patients to generate those cases. If you need the patients then you're going to need pediatricians and Pediatric nurses and on and on. Same could be said for FP residencies....you have to have the full spectrum of patients to maintain programs.




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I know the many of the people who were passed over in the Navy for O-5 this year. Many of these are top performers, fellowship trained etc. I'm trying not to be bitter about it, or make it personal, and I acknowledge folks can grow after training, but I also know some on the list left clinical medicine early in their careers and may not have been top clinical performers. 2 out of 7 in ortho is f&!*ing travesty, I am sure that is because they were in training for a significant part of their O-4 years. Hard to have some bull#@! admin title while finishing your interminable surgical residency. I thought we needed 'trauma' doctors to fulfill the mission? I do everything I can to dispel the fallacious belief that you can just hire civilian physicians to fill jobs in MEDCENs and MEDDACs whenever someone brings it up. This is false, unless you are willing to pay double or hire out of the highly questionable locum tenens pool.
 
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You want another piece of the puzzle that will get you going as well: if you are in inservice residency or fellowship when you go to the O5 board you appear to have a very good chance at being selected. My n is low (maybe 4-5 direct knowledge cases) but all except one have been selected for promotion. Good luck if you are FTOS or deferred.

I would agree with your discussion regarding just being out of training (for those with longer residencies and frequent GMO tours required) except the numbers for IM and FP are also really low and they don't have that issue as often.


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..you have to have the full spectrum of patients to maintain programs.




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Or eliminate GME altogether. Arguing that it's all or none is a risky proposition.

O4 to O5 promotion should be 100%. It's the MD equivalent of a line JG and LT. these are the working ranks. They can make O6 selective but those numbers are so unfair.

Oh, and double wouldn't bring me back. Would have to be closer to triple the max GS rate. I'd think about it for 2.7x.
 
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In zone promotion to CDR was 39.9% this year. With their fuzzy math it was 70%, but that includes 3 below zone and a bit shy of half the selections being from the above zone group.


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Wow that sounds brutal, but I've been out in civilian land now for a couple of years.
 
Yeah, those are brutal. I wish I had a better idea what to make of it, but those are all pretty large specialties where the "younger folk" are probably getting left out cold when it comes to higher level departmental jobs within the commands by the O5's who are trying to make O6. I know for O6 I think radiology had a near 100% select rate to O6 (if memory serves me).

As to the NDAA question: I'm not sure if it's that directly or more the beginning of the DHA takeover. I think the GME portion is still to be fully realized, but there was certainly some significant background work going on trying to quantify the number of people involved and the cost associated with GME over the last year. From what I have heard the Services are planning on justifying all GME based on the need to support the higher profile programs. For example, you can't have a general surgery program if you don't have Pediatric patients to generate those cases. If you need the patients then you're going to need pediatricians and Pediatric nurses and on and on. Same could be said for FP residencies....you have to have the full spectrum of patients to maintain programs.




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As it turns out, the Army (at least) doesn't agree that you need the full range of patients to run a program. WBAMC has what amounts to no inpatient pediatrics. But yet they do have residency programs, to include general surgery. Their answer is always the same: just send the residents out to train elsewhere.

We had crap oncology volume, so we always went out to get it. And don't get me wrong, I loved my outside rotations (and not just because freedom is so, so sweet), but it isn't the same as being able to take care of those patients at home.
 
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..... I thought we needed 'trauma' doctors to fulfill the mission? I do everything I can to dispel the fallacious belief that you can just hire civilian physicians to fill jobs in MEDCENs and MEDDACs whenever someone brings it up. This is false, unless you are willing to pay double or hire out of the highly questionable locum tenens pool.

I met numerous Army physicians while I was at Landstuhl a few years ago. To a man/woman, they complained about skill atrophy when assigned to the smaller Army community hospitals, especially those lacking an ICU, lacking cardiology, etc. They were limited to doing just outpatient ambulatory stuff, including c-scopes ad nauseum. A lap chole or TAH was a "big" case. An ortho "big" case might be an active duty ACL repair. No total joints. This is especially frustrating when the attending is fresh from residency and wants to refine their skills but the facility can't support it. Made even worse when a particular new-grad surgeon is the entire 1-of-1 department with no senior departmental colleague available for consultation.

I also heard stories of moving towards a system where active duty are kept at the bigger MEDCENs where they have all the support they need to do big cases. The smaller community hospitals will be staffed by civil servants and/or locums. Really? What type of quality physicians are going to move to Fort Nowhere at government pay except for the occasional 30 year retiree West Point grad lifer for life? Does DHA have a line of folks at the employment office door begging to be let in? And the locums folks? Horror stories of revolving doors of scary OBGYN locums/contractors at Fort Nowhere.
 
Not to put too fine a point on it, but the Navy O5 board was a bloodbath this year. Some of the worst specialties this year:

27% in zone selection rate for anesthesia (3 of 11).

2 of 14 for surgery.
2 of 7 for ortho.
5 of 15 for FP.
6 of 13 for rads.

40% overall all specialties.

It's something to behold.

Dismal and absurd. Is this b/c too many O-5s and O-6s are staying in? Can't get the job you want as a civilian anesthesiologist in sunny San Diego, so you'd rather stay on AD and collect that O-5/O-6 paycheck? I dunno......

For us juniors: best advice I would give, is to just do whatever the F you want (with respect to your choice of assignments, training, etc). Don't take that managerial/operational/clinic job unless you really want to do it. Nothing seems to consistently help for promotion, so you might as well do whatever you actually want to do.
 
Full speed ahead for my specialty. Doubled the number of fellowship spots this year

I haven't seen any correlation between this years Navy GMESB goals and what we are hearing regarding billet reductions. Not sure I'd use that as a measuring stick....unfortunately.


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@DrMetal i would caveat that slightly. Do what you want but don't delay training. You don't know what will happen so don't pass up or delay applying for what you want.
Oh I definitely agree. Becoming BE/BC'd in your specialty or sub-specialty of choice should be way more meaningful to you than making O-5. [difference between O-4 and O-5 pay is about $800-1000 per month, depending on your BAH. Use your civilian credentials to moonlight a little, you'll make that up in spades. [I know I know, you shouldn't have to moonlight to make up for lack of a promotion that you should have received...but so be it....I'd still rather do what I want (training included)....damn the promotion.]
 
Dismal and absurd. Is this b/c too many O-5s and O-6s are staying in? Can't get the job you want as a civilian anesthesiologist in sunny San Diego, so you'd rather stay on AD and collect that O-5/O-6 paycheck? I dunno......

The pension is a compelling carrot for people past about 12 years.

From 2008 - 2014 or so I think there was more fear about the civilian job market, what with the recession and Obamacare. I think a lot of fence sitters stayed on active duty a couple extra years because of that, and then found themselves around the magic 12 year mark.

I'd also speculate that we staffed up during the heyday of the Iraq and Afghanistan wars, and about now is when a bunch of those mid 2000s accessions are hitting the O5 boards. Maybe there are just a lot more in-zone O4s around these days? I don't know. That stuff is out of my lane.


For us juniors: best advice I would give, is to just do whatever the F you want (with respect to your choice of assignments, training, etc). Don't take that managerial/operational/clinic job unless you really want to do it. Nothing seems to consistently help for promotion, so you might as well do whatever you actually want to do.

I wouldn't burn any bridges, but you're right, it can be demoralizing to put in extra effort and not be rewarded.

The advice I would give is to take on local collateral duties to effect local change, to make your area a better place to work, and a better place for patients. After all ... you're stuck working there, right?

It's tempting to just say F it, and step back and not take on any leadership positions. But the end game there is abdicating leadership to the nurse corps and that sure isn't good for the hospital, for health care, for patients, or for us. The nurses will take those administrative positions. They're standing by ready to step in.
 
I haven't seen any correlation between this years Navy GMESB goals and what we are hearing regarding billet reductions. Not sure I'd use that as a measuring stick....unfortunately.

Peds looks like they have 2 less spots

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I haven't heard anything official, but what I'm observing speaks volumes. A number of billets in my subspecialty and my wife's subspecialty have seen separating or retiring AD doc billets replaced with contractors instead of AD docs. This is occurring at the medium sized outlying hospitals. The billets created at the big MEDCENS by retirement/separation are being filled by people already in fellowship/residency who are staying on at the big MEDCEN instead of being shipped out to the medium sized hospital for their first utilization tour (as was done in the past).

I don't have visibility of overall medical corps numbers, but the number of AD docs in our specialties dwindles each year. I'm on record having said that MILMED will move to the British system in my lifetime. Perhaps the winnowing has begun.
 
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