what does the navy call a bed? - tulane...

NAVY NAVY NAVY NAVY Justin G. MillerJustin G. MillerJustin G. MillerJustin G. MillerENS MC USNENS MC USNENS MC USNENS MC USN

What does the Navy call a bed?

A Rack

What does the Army call a bed?

A Cot

What does the Air Force call a bed?

A Single with a ruffle duvet cover

Tertiary Care CentersTertiary Care CentersTertiary Care CentersTertiary Care Centers1. National Naval Medical Center Bethesda1. National Naval Medical Center Bethesda1. National Naval Medical Center Bethesda1. National Naval Medical Center Bethesda2. Naval Medical Center Portsmouth2. Naval Medical Center Portsmouth2. Naval Medical Center Portsmouth2. Naval Medical Center Portsmouth7. Naval Medical Center San Diego7. Naval Medical Center San Diego7. Naval Medical Center San Diego7. Naval Medical Center San DiegoFamily PracticeFamily PracticeFamily PracticeFamily Practice3. Naval Hospital Camp Lejeune3. Naval Hospital Camp Lejeune3. Naval Hospital Camp Lejeune3. Naval Hospital Camp Lejeune4. Naval Hospital Jacksonville4. Naval Hospital Jacksonville4. Naval Hospital Jacksonville4. Naval Hospital Jacksonville5. Naval Hospital Pensacola5. Naval Hospital Pensacola5. Naval Hospital Pensacola5. Naval Hospital Pensacola8. Naval Hospital Camp Pendleton8. Naval Hospital Camp Pendleton8. Naval Hospital Camp Pendleton8. Naval Hospital Camp Pendleton9. Naval Hospital Bremerton9. Naval Hospital Bremerton9. Naval Hospital Bremerton9. Naval Hospital BremertonNOMINOMINOMINOMI6. Naval Operational Medicine Institute6. Naval Operational Medicine Institute6. Naval Operational Medicine Institute6. Naval Operational Medicine Institute

Navy Residencies

• Over 4000 Navy Physicians • 1000 Navy Physicians in training at any given time• 60 Navy residency programs with 895 residency

openings • All Navy GME sites have maximum institutional

accreditation • Excellent 1st time Board pass rate in all specialties • FULL PAY AND BENEFITS• Navy- >95% 1st time Board Pass Rate • Civilian- 80 - 85% 1st time Board Pass Rate

Navy Graduate Board Pass Rates2004 Board Certification Pass Rates2004 Board Certification Pass Rates2004 Board Certification Pass Rates2004 Board Certification Pass Rates

First Time ExamineesFirst Time ExamineesFirst Time ExamineesFirst Time ExamineesNavy-vs-National AveragesNavy-vs-National AveragesNavy-vs-National AveragesNavy-vs-National Averages

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Anesth

esiolo

gy

Dermato

logy

Emergen

cy Medic

ine

Family Med

icine

Interna

l Med

icine

IM - C

ard

IM - E

ndo

IM - G

I

IM - H

eme/O

ncIM

- ID

IM - P

ul/CC

Neurolog

y

Neurosu

rgery

OB/GYN

Ophtha

lmolo

gy

Orthope

dic Surge

ry

Patholo

gy

Pediatr

ics

Preven

tive M

edicine -

Aero Med

Psychia

try

Radiolo

gy

Surgery

Urology

SpecialtySpecialtySpecialtySpecialty

Navy Pass RateNat'l Pass Rate

Navy Residencies• Anesthesiology

– Balboa: 3 year program, 6 residency spots, no intern spots. – Bethesda: 3 year program, 6 residency spots, no intern spots. – Portsmouth: 3 year program, 6 residency spots, no intern spots.

• Dermatology– Balboa: 3 year program, 5 residency spots, no intern spots. – Bethesda: 3 year program, 2 residency spots, no intern spots.

• Emergency Medicine– Balboa: 3 year program, 8 residency spots, no intern spots. – Portsmouth: 3 year program, 10 residency spots, no intern spots.

• Family Medicine– Bremerton: 3 year program, 6 residency spots, 6 intern spots. – Camp Lejeune: 3 year program, 6 residency spots, 6 intern spots. – Camp Pendleton: 3 year program, 12 residency spots, 12 intern spots. – Jacksonville: 3 year program, 13 residency spots, 13 intern spots. – Pensacola: 3 year program, 7 residency spots, 7 intern spots.

Navy Residencies• Internal Medicine

– Balboa: 3 year program, 12 residency spots, 20 intern spots. – Bethesda: 3 year program, 10 residency spots, 20 intern spots. – Portsmouth: 3 year program, 10 residency spots, 20 intern spots.

• Neurology– Bethesda: 3 year program, 2 residency spots, no intern spots.

• Neurosurgery– Bethesda: 6 year program, 1 residency spot, no intern spots.

• Obstetrics and Gynecology– Balboa: 4 year program, 5 residency spots, 6 intern spots. – Bethesda: 4 year program, 3 residency spots, 3 intern spots. – Portsmouth: 4 year program, 5 residency spots, 5 intern spots.

• Ophthalmology– Balboa: 3 year program, 4 residency spots, no intern spots.

Navy Residencies• Orthopedics

– Balboa: 4 year program, 5 residency spots, 5 intern spots. – Bethesda: 4 year program, 3 residency spots, 3 intern spots. – Portsmouth: 4 year program, 3 residency spots, 3 intern spots.

• Otolaryngology– Balboa: 5+1 year program, 2 residency spots, 2 intern spots. – Bethesda: 4+1 year program, 2 residency spots, 2 intern spots. – Portsmouth: 4+1 year program, 2 residency spots, 2 intern spots.

• Pathology– Balboa: 4 year program, 3 residency spots, no intern spots. – Bethesda: 4 year program, 2 residency spots, no intern spots.

• Pediatrics– Balboa: 3 year program, 8 residency spots, 8 intern spots. – Bethesda: 3 year program, 5 residency spots, 3 intern spots. – Portsmouth: 3 year program, 8 residency spots, 8 intern spots.

Navy Residencies• Psychiatry

– Balboa: 3 year program, 4/5 residency spots, 5 intern spots. – Bethesda: 3 year program, 4 residency spots, 4 intern spots. – Portsmouth: 3 year program, 4/5 residency spots, 5 intern

spots.

• Radiology– Balboa: 4 year program, 6/7 residency spots, 0 intern spots. – Bethesda: 4 year program, 4/5 residency spots, 0 intern spots. – Portsmouth: 4 year program, 5 residency spots, 0 intern spots.

Navy Residencies• Surgery

– Balboa: 4 year program, 4 residency spots, 15 intern spots. – Bethesda: 4 year program, 3 residency spots, 10 intern spots. – Portsmouth: 4 year program, 3 residency spots,12 intern spots.

• Transitional Year– Balboa: 27 intern spots. – Bethesda: 12 intern spots. – Portsmouth: 25 intern spots.

• Urology– Balboa: 4 year program, 1/2 residency spots, no intern spots. – Portsmouth: 4 year program, 1 residency spot, no intern spots.

Can an HPSP student do a civilian residency?

• YES• All HPSP apply to Navy Selection Board

– List preferences – inservice, deferment

• Priority given to filling Navy internships• Each year there will be some deferments

Can an HPSP student do a civilian residency?

• If selected for full deferment won’t come active duty until training completed. (won’t be pulled to be a GMO)

• No pay or benefits from the Navy while in residency

• Does not incur any additional payback time

How Much Time Do I Owe Again?• Obligation of 1 year for each year of

sponsorship, served in a non-training status.

• Minimum Service Obligation (MSO) of 3 years (impacts 1 and 2 year recipients).

• Intern year counts towards MSO• Residency (not internship) incurs year for

year training obligation served concurrently with remaining HPSP obligation

How Much Time Do I Owe Again?

• Pay back occurs when the member is not in training.

• Time spent as a GMO, Flight Surgeon, or Undersea Medical Officer counts toward payback.

• Residency obligation is paid back concurrently with HPSP obligation.

How many HPSP graduates are selected for deferred residency training each year?

• Number varies from year to year– Depends on size of HPSP class

• Filling inservice programs is priority• The larger the medical school class the

greater the number of full deferments.• Majority of full deferments in most

needed specialties: Gen Surgery, Ortho, Anesthesia

Medical School GraduatesMedical School GraduatesMedical School GraduatesMedical School GraduatesFull Deferments & Inservice Straight-Through TrainingFull Deferments & Inservice Straight-Through TrainingFull Deferments & Inservice Straight-Through TrainingFull Deferments & Inservice Straight-Through Training

0

50

100

150

200

250

300

Medical School ClassMedical School ClassMedical School ClassMedical School Class

Numb

erNu

mber

Numb

erNu

mber

Intern Grads to Op Tours 246 240 219 194 218 202 210 190 190

Full Deferments 108 50 4 16 12 42 48 9 73

Inservice Straight-Through 46 80 78 68 79 85 66 68 85

97 98 99 00 01 02 03 04 05

Full Deferments - Class of 2005 349 graduates

AnesthesiologyAnesthesiologyAnesthesiologyAnesthesiology 15151515Emergency MedEmergency MedEmergency MedEmergency Med 9 9 9 9Family MedFamily MedFamily MedFamily Med 2 2 2 2Int MedInt MedInt MedInt Med 5 5 5 5NeurologyNeurologyNeurologyNeurology 2 2 2 2NeurosurgeryNeurosurgeryNeurosurgeryNeurosurgery 2 2 2 2Ob/GynOb/GynOb/GynOb/Gyn 3 3 3 3

Ortho Ortho Ortho Ortho 13131313PathologyPathologyPathologyPathology 3 3 3 3RadiologyRadiologyRadiologyRadiology 2 2 2 2Gen Gen Gen Gen SurgSurgSurgSurg 13131313UUUUrologyrologyrologyrology 4 4 4 4

Are all HPSP graduates required to do a GMO tour after internship?

• No• 30-40% will not have a GMO tour by

either full deferment or straight through training before serving their active duty obligation.

What is a GMO?• Primary care physician who usually works

in an operational area such as: – Flight Surgeon – Undersea Medical Officer – Marines – Construction Battalion – Hospitals – Clinics – Overseas – Ships

Flight Surgery

• 6 months training in Pensacola.• Perform basic flight training.• Study unique aspects of aerospace

medicine.• Assigned as Squadron or Station FS.• 2-3 year tour (24 month minimum).• Eligible to apply for Residency in

Aerospace Medicine after first tour.

Undersea Medicine

• 6 months training in Groton, CT and Panama City, FL.

• Study the unique aspects of hyperbaric medicine.

• Become a certified Navy diver.• 2-3 year tour (24 month minimum).• Serve the needs of the submarine and

diving communities.

My Recruiter Said That GMO Tours Were Going to GO Away

• Navy Medicine is working to convert GMO billets to Primary Care billets.

• Moving towards an all board eligible force.• By 2011 GMO/FS/UMO billets will be

drastically reduced.• This will increase the opportunities for

straight through training each year as the transition of billets occurs.

How Do I Go Straight Though Residency?

• Apply for your GME-2 year during your internship

• Who may apply?– Any intern associated with the Navy – Operation Medical Officers (GMO, FS, UMO)– Staff physicians

How many interns are selected for straight-through training each year?

• 65-85/year• Most likely in Family Medicine, Internal

medicine, Ob/Gyn, Psychiatry and Pediatrics

• Less common in many others

Straight-Through Training

• LikelyLikelyLikelyLikely– Family PracticeFamily PracticeFamily PracticeFamily Practice– Internal Internal Internal Internal

MedicineMedicineMedicineMedicine– PsychiatryPsychiatryPsychiatryPsychiatry– Ob/GynOb/GynOb/GynOb/Gyn– PediatricsPediatricsPediatricsPediatrics– General SurgeryGeneral SurgeryGeneral SurgeryGeneral Surgery

• LikelyLikelyLikelyLikely– Family PracticeFamily PracticeFamily PracticeFamily Practice– Internal Internal Internal Internal

MedicineMedicineMedicineMedicine– PsychiatryPsychiatryPsychiatryPsychiatry– Ob/GynOb/GynOb/GynOb/Gyn– PediatricsPediatricsPediatricsPediatrics– General SurgeryGeneral SurgeryGeneral SurgeryGeneral Surgery

Straight-Through Training (2004-2005)

Internal MedicineInternal MedicineInternal MedicineInternal Medicine 20202020Family Medicine Family Medicine Family Medicine Family Medicine 16161616Ob/GynOb/GynOb/GynOb/Gyn 10101010PsychiatryPsychiatryPsychiatryPsychiatry 7777PediatricsPediatricsPediatricsPediatrics 5555General SurgeryGeneral SurgeryGeneral SurgeryGeneral Surgery 4444AnesthesiologyAnesthesiologyAnesthesiologyAnesthesiology 2222OrthopedicsOrthopedicsOrthopedicsOrthopedics 2222PathologyPathologyPathologyPathology 1111

Straight-Through Training (2005-2006)

Family Medicine Family Medicine Family Medicine Family Medicine 19191919Internal MedicineInternal MedicineInternal MedicineInternal Medicine 19191919Ob/GynOb/GynOb/GynOb/Gyn 9999PsychiatryPsychiatryPsychiatryPsychiatry 6666PediatricsPediatricsPediatricsPediatrics 4444General SurgeryGeneral SurgeryGeneral SurgeryGeneral Surgery 3333OrthopedicsOrthopedicsOrthopedicsOrthopedics 2222

Will the Navy force an HPSP graduate to training in a residency they don’t

want?• No• Navy doesn’t offer training in some

specialties• Officer may elect to serve out

obligation and leave the service

Is residency going to be just like a boring civilian residency?

• NO• You will have opportunities to take any of the following

courses:– Tropical Medicine Course – Cold Weather Medicine Course – Combat Casualty Care Course (C4)– Naval War College - College of Distance Learning – Basic Medical Department Officers Course – Clinic Management Course – Hyperbaric Medicine Team Training Course – Global Medicine Course – Plans, Operations, and Medical Intelligence Course – Marine Corps Mountain Wilderness Training

I’m a 3rd year Navy HPSP student, what do I do?

• Admin/Medical: Don’t forget about the Academic Year Statement and biennial HIV test.

• Schedule ATs: One before and one after 01OCT

• GME-1 Application: – You will receive this in the spring of your third year.

It must be completed by July, but can be modified until November

• USMLE: Schedule Step 2 CK/CS– CK scores must be received before late November

and CS must be passed so you can supersede to Lieutenant

Admin/Medical

• If you don’t submit your Academic Year Statement you wont get paid.

• You received an HIV test at ODS

Scheduling ATs: One before and one after 01OCT- Schedule during Jan/Feb

• NNMC Bethesda– NEURO, OTO, PSY, SUR and TRA: Ms. Karshan Allen, karshan.allen@med.navy.mil or (301) 295-5457 , (301)

295-5457– INT MED: Ms. Kathryn Bomysoad, Kbomysoad@usuhs.mil or (301) 295-5790 , (301) 295-5790– OB/GYN: Ms. Penny Croyle, PCroyle@usuhs.mil or (301) 295-2048 (301) 295-2048– ORTHO: Ms. Alice Anderson, alice.anderson@med.navy.mil or 301-319-4196 301-319-4196– PEDS: Ms. Monique Kinard, monique.kinard@med.navy.mil or (301) 295-4898 (301) 295-4898

• NMC Portsmouth– Ms. Dottie Vexler, dorothy.vexler@med.navy.mil or (757) 953-7371 (757) 953-7371

• NMC San Diego – Ms. Alexandra Littleton alexandra.littleton@med.navy.mil (619) 532-9405 (619) 532-9405

• NAVHOSP Bremerton– Ms. Lina Mendiola, lina.mendiola@med.navy.mil or (360) 475-4339/4345

• NAVHOSP Camp Lejeune– Ms. Rae Griggs, rae.griggs@med.navy.mil or (910) 450-3138 (910) 450-3138

• NAVHOSP Camp Pendleton– Ms. Willa Moore, willa.moore@med.navy.mil or (760) 725-0406 (760)

• NAVHOSP Jacksonville– Ms. Vicky Wolff, vicky.wolff@med.navy.mil or 904-542-7762 904-542-7762

• NAVHOSP Pensacola– Ms. Barbara Hart, barbara.a.hart@.med.navy.mil or (850) 505-6472 (850) 505-6472

Scheduling ATs: One before and one after 01OCT- Schedule during Jan/Feb• Operational

– Undersea Medicine– USMC Operational Medicine (Field Medicine School)– Flight Medicine– Locations- San Diego, Pensacola, Camp Lejeune,

Norfolk• Research Institutes

– AFRI, NMRI – Bethesda– NSMRL, NUMI – New London– NAMRI – Pensacola– Experimental Dive Unit – Panama City

GME-1 Application

GME-1 Application• You will receive this in the spring of your third

year. It must be completed by July, but can be modified until November

• Rank List from 1 to 5• My list:

– 1. Surgery- Bethesda– 2. Surgery- Portsmouth– 3. Surgery- Balboa– 4. Transitional- Portsmouth– 5. Transitional- Any Site

GME-1 Application• Whatever specialty a student selects for choice 1, all

other sites that provide that training must also be ranked. – For example, if a student selects Internal Medicine at

Portsmouth for first choice, San Diego and Bethesda must be ranked as numbers 2 and 3 (in either order).

• If a Family Medicine Program is selected, all five programs must be ranked. Students may request a full deferment, but if there is a Navy categorical internship in the deferment specialty requested, all Navy sites must be ranked as well.

• Deferment may be placed in any position except position 5.

GME-1 Application- Example Rank Lists

• 1. Gen Surg- SD• 2. Gen Surg- Beth• 3. Gen Surg- Ports• 4. Trans- SD• 5. Trans- Any Site

• 1. Rad- Full Def• 2. Gen Surg- Beth• 3. Gen Surg- Ports• 4. Gen Surg- SD• 5. Trans- Any Site

How Does Selection Board Work?• A student makes his/her ranking list. • Program Directors are given a list of all students who have ranked

their program. – The Program Directors are NOT told the student rankings.

• Program Directors must make their list based purely on the student’s record and interactions.

• Then the lists will be paired, matching the desires of the student with the program. Preference will be given to the student.Preference will be given to the student.Preference will be given to the student.Preference will be given to the student.

• Special circumstances are considered by the Selection Board. Items that can be considered are co-location with a military spouse and family issues or needs.

• The Board places high priority on meeting these location needs, but it can not guarantee specialty of choice.

USMLE

• Schedule your test dates during Jan/Feb• CK scores must be received before late

November and CS must be passed so you can supersede to Lieutenant

I’m a 4th year Navy HPSP student, what do I do?

• Admin/Medical: Academic Year Statement and biennial HIV test

• USMLE Step 2: take tests and submit testing fees for reimbursement

• ATs: One before and one after 01OCT• Interviews• GME-1 Application: Finalize rank list• ERAS: have all LORs and PS submitted and ERAS

completed before the selection committee meets

Interviews • Uniform- SDB or Summer Whites. This

depends on the time of year and the hospital.

• Bring a copy of your CV and Personal Statement

• Interviews are usually done at the last week of your clerkship

• Contact site GME coordinator at the BEGINNING of the clerkship to set up the interview

My Experience

• 1 month Sub-I in general surgery at Portsmouth 19JUN -13AUG

• 3 week clerkship in trauma surgery at Bethesda 01OCT – 22OCT

Portsmouth- General Surgery Sub-I

• Competitive general surgery program• Hospital receives no trauma, but

residents spend 6 months at local trauma hospital

• Chief residents log more cases than the national average- most cases are routine surgery cases

• Most patients are Norfolk AD and family

Bethesda- Trauma Surgery Clerkship

• NNMC is in the process of merging with Walter Reed

• Hospital receives most trauma patients from overseas

• Chief residents log more cases than the national average- diverse cases, as seen in most academic centers

• Serves AD and retired populations

POCs• NAVMED MPT&E Accessions Department

Code OH

• Program Manager: CAPT(ret.) Dr. Yerkes (301)295-9950• Student Programs: CDR Dr. Sanchez (301) 295-1217• Registrar: CDR(ret.) Fran Smith (301) 319-4526 • Deputy Prog Mgmr: LT Yolanda Adams (301) 319-4531• Tuition: PS1(ret.) Mr. Dion Woodard (301)295-9977• Travel: PS1 (ret.) Mr. Jon Green (301) 319-4538• Personnel Support: PS1 (ret.) Mr. Sean Hughes: (301) 319-4529• Reimbursements: Ms. Fundersburg:(301) 295-9978• Medical Internship: HMC(ret.) Pelot (301)319-4517• Dental HPSP: Ms. Sampson (301) 295-1594• E-mail: OH@med.navy.mil

Questions?

jmiller7@tulane.edu