FELLOWSHIP TRAINING Maj Barton Staat OBJECTIVES Describe the process of fellowship application and various types of opportunities available Discuss the various pros and cons of fellowship training Identify potential financial considerations of fellowship training both within the military and as a civilian ARE THERE FELLOWSHIP SPOTS EVERY YEAR? Health Professions Education Requirements Board (HPERB) Previously known as Integrated Forecast Board (IFB) All Corps (MC, NC, DC, MSC, BSC) define approved training requirements Joint Service GME Selection Board: Nov/Dec Selection and placement of all AF obligated physicians / medical students in residency and fellowship specialty training WHAT IS THE BOARD? Joint Service Graduate Medical Education Selection Board Process by which all obligated officers are selected for residencies and fellowships All obligated officers must apply to and be approved by the JSGMESB in order to enter a GME program (military or civilian) BACKGROUND ON THE BOARD Tri-service process Panel members - Senior Medical Corps officers Specialty consultants Residency / Fellowship Program Directors Specialty panels score applicants and present selections to: 1) Management Level review panel (MLR) Identify issues of concern 2) Board President panel Board President has final decision in selection process WHY DON‟T WE HAVE MORE FELLOWSHIP SPOTS? Health Professions Education Requirements Board (HPERB) Process by which Air Force determines number of training positions to be offered in each specialty Train according to Military needs Approved Approved unfunded Civilian Sponsored Deferred AIR FORCE HPERB RESULTS OB/GYN 2011 Residency, OB/GYN 3-SAMMC; 3-WP/WS ; 1-USUHS 48 Jul-12 2-Portsmouth; 11 Def/Rdef 48 months Fellowship, Endoscopy 1-Civilian Sponsored 24 Fellowship, Oncology 1-Walter Reed 48 months Fellowship, REI 1-Civilian Sponsored 36 months Fellowship, MFM 1-Civilian Sponsored 36 http://airforcemedicine.afms.mil/afphysiciangme ARMY FELLOWSHIPS GYN Oncology at NCC-Walter Reed, Gynecologic Minimally Invasive Surgery at NCC- Walter Reed (2012 Start) Maternal Fetal Medicine at Madigan Army Medical or Army sponsored civilian training REI Civilian sponsored GYN Laparoscopy as well as Reproductive Endocrinology and Urogynecology at Army sponsored civilian training at the National Institute of Health (NIH) - in collaboration with the National Capital Consortium. Applicants who desire training in Reproductive Endocrinology or Urogynecology at the NIH/NCC program must indicate their training preference as civilian sponsored under Army on their DoD application http://www.mods.army.mil/MedicalEducation/ SPONSORED, DEFERRED OR AD? CIVILIAN SPONSORED You will be AD during You will continue to civilian fellowship progress in years of Same pay as OB Staff service (approximately twice You will be eligible for what you would earn as promotion a civilian fellow) Minimal military Progress towards obligations retirement (PT test, urine drug Some programs view screen, medical and dental appt) sponsored as highly desirable (they can‟t pay You owe one additional you/you are free labor) year for each year of sponsored training that will be served after other obligations SPONSORED, DEFERRED OR AD? Civilian Deferred Rarely offered for fellowship training Average pay for fellow $65K SPONSORED, DEFERRED OR AD? ACTIVE DUTY Staff pay Additional commitment Continue to gain years is served consecutively towards (IE if you have 4 years promotion/retirement of HPSP obligation you would not owe more Less choice in program than the 4 already but if selection you only owe 2 years before fellowship you will add an extra year for 3 year fellowship) Typically not as extensive of research opportunities/mentors at AD fellowships. WHEN WILL I KNOW ABOUT FELLOWSHIP SPOTS? Mid June Sept 15th Mid Dec HPERB JSGMESB JSGMESB releases application results results due released WHAT DO I HAVE TO SUBMIT? DOD Application Current PD evaluation 2 page application form CV PD evaluation form Personal statement from previous programs Education summary Current fitness test Other supporting score documents Copy of unrestricted USMLE / COMLEX medical license (for scores- Steps 1, 2 and 3 trainees in year PGY3 Medical school records or greater) Transcripts Current Interns, STEP Dean‟s Letter (MSPE) 3 Program Director‟s Interview sheet Letters of recommendation WHAT IF I WAIT UNTIL I‟M STAFF? PD evaluation form from residency program(s) Current fitness test score Copy of unrestricted medical license Commander‟s letter of recommendation Last 5 OPR / TRs „07, „08, „09, „10, and „11 reports Board Certification Other issues Time on station, DEROS (overseas applicants), 2nd residencies, Colonels or Colonel selects May require waiver by board president to enter GME WHAT WILL THEY LOOK AT? Application factors considered Applicant‟s motivation toward specialty Medical school performance Residency performance Active duty tours Interview sheet Personal factors (joint spouse, family issues, etc) Priority is to fill active duty programs first HOW DOES THE BOARD RANK YOU? Tri service scoring Rating based on Preclinical med school performance Clinical med school performance Internship Residency Operational tour Potential for success Bonus points Research Prior service WHAT CAN I DO TO BOOST MY SCORE? Up to 4 points can be awarded for research Each scoring panel determines their criteria for awarding research points Sample guidelines One poster / abstract 1 point Two or more 2 points Single pub (peer reviewed) 3 points Multiple pubs 4 points Current medical students can only receive a maximum of 2 research points WHEN TO APPLY R3, R4 OR STAFF? Carpe Diem! Difficult to predict when fellowship positions will be available for various specialties. Some specialists stay in longer than predicted and some get out unexpectedly Some years there may be one or two fellowship opportunities and then there may be several years without a fellowship position and hard to tell how competitive the military board will be. R3 if given a spot will go straight through from residency to fellowship R4 would be staff for one year prior to fellowship, it will require coordination and likely to stay on as staff I WAS SELECTED! NOW WHAT? TIPS TO BETTER YOUR CHANCES OF GETTING SELECTED Whole person concept Perform well on rotations in your desired specialty Contribute to your residency program Make fellowship PD aware of your interest Present at regional and / or national meetings Turn abstracts into papers Meet deadlines - Deadlines are firm Consider doing a tour as a staff physician Have a back up plan TIPS FOR FELLOWSHIP SELECTION I attended the SMFM meeting as a 3rd year resident and met with fellowship directors from programs I was most interested in. Most fellowship directors are required to attend the specialty meeting ASRM, SGO, SMFM , AUGS Explain what civilian sponsored means Many programs have not ever had a military fellow May open some doors, especially with tight academic budgets Make sure if you want to go to a certain program that they know your desire to attend their program Know what types of research the program does ½ of time in fellowships are spent doing research and part of graduation requirement and board certification is a thesis Consultants and fellowship programs will ask you about your research interests. (hint “I don‟t really like research” has been said and is poor form) CIVILIAN FELLOWSHIP LINKS MFM https://www.smfm.org/MFM%20Fellowship%20Page.cf m REI http://www.socrei.org/uploadedFiles/Affiliates/SOCREI/ Fellowships/REIFellowshipPrograms.pdf Gyn-Onc http://www.sgo.org/Membership/Resources_for_Candid ates_and_Fellows/Fellowship_Programs/ Urogyn https://www.augs.org/Fellows/FellowsResources/tabid/2 12/Default.aspx FINANCES Obviously you should do a fellowship because you are passionate about the specialty But…what will the pay difference be within the military if I stay for retirement and when are pay implications when I get out? MILITARY PAY (LOTS OF ACRONYMS!) Bonuses: VSP Board Certified Pay ASP ISP MSP MISP/MSP ECISP MILITARY PAY: VSP VSP Variable Special Pay “Pay for being a doctor” – Yes, even an intern No commitment, no contract Pay Under ≥ 3 ≥6 ≥8 ≥ 10 ≥ 12 ≥ 14 ≥ 18 ≥ 22 Grade 3 <6 <8 <10 <12 <14 <18 <22 Intern $100 Thru 06 $416.66 $1000 $958.33 $916.66 $833.33 $750 $666.66 $583.33 Above $583.33 06 MILITARY PAY:BOARD CERTIFIED Board Certified Pay – ABMS recognition – “Pay for being board certified doctor” • No commitment, no contract Pay Under ≥ 10 ≥ 12 ≥ 14 ≥ 18 Grade 10 < 12 < 14 < 18 All 208.33 $291.66 $333.33 $416.66 $500 – So, by 22 yrs, you will lose $420/m VSP, and gain $290/m on board certified pay BONUS SYSTEM ASP Additional Special Pay “Pay to retain you as a physician post residency” Pay period: Upon GME graduation typically 1 Jul – 30 Jun Rate is fiscally decided, presently $15,000 i.e. 1 Jul 2010 ASP rate set on 1 Oct 2009 Commitment 1 Year Concurrent BONUS SYSTEM ISP Incentive Special Pay “Pay for being a specialist or subspecialist” Pay period: DoD policy generally precludes payment of and ISP during the fiscal year in which the qualifying residency training is completed. Upon GME graduation typically 1 Oct – 30 Sep, unless fellowship Rate is fiscally decided i.e. 1 Oct 2010 ISP rate set on 1 Oct 2010 Typically delayed… Commitment 1 Year Concurrent BONUS SYSTEM ISP Rate: General OB/Gyn - $31k, Subs - $36k Pay period: Fiscal Year – 01 Oct thru 30 Sep Exception: A medical officer with an existing single-year ISP contract may terminate that contract on or after October 1, of that fiscal year, in order to enter into a new single-year contract only when the new contract will result in a higher ISP rate than the ISP contract being terminated. Example: Fellowship training NOTE: This provision is not intended to allow medical officers to arbitrarily terminate an agreement solely for the purpose of changing the anniversary date to coincide with an Additional Special Pay agreement or a resignation/release from active duty. BONUS SYSTEM MISP/MSP Multiyear Special Pay “Pay to retain you longer as a specialist” Pay period: Except, must have 8 yrs creditable service CAN BE RENEGOTIATED AT ANYTIME DURING MSP PERIOD Typically 1 Oct – 30 Sep for 2, 3 or 4 years Rate is fiscally decided i.e. 1 Oct 2010 MSP rate set on 1 Oct 2010 Commitment 2, 3, or 4 years MISP 2 3 4 ** Consecutive ** Gener $31k $17k $25k $35k al Subs $36k $21k $31k $45k WHAT DO I MAKE NOW? Assumptions VSP $1000/mo Major $12,000 10yr BCP $208.33/mo Living in San Antonio $2,500 Has dependents ISP $36,000/annual Board Certified ASP $16,000/annual Sub-specialist Basic pay $6,659.40/mo $79,912.8 Housing $1,719/mo $20,628 BAS $223.04/mo 2,676.48 $169,717.04 WHAT WOULD I MAKE AS A GENERALIST? Assumptions VSP $1000/mo Major $12,000 10 BCP $208.33/mo Living in San Antonio $2,500 Has dependents ISP $31,000/annual Board Certified ASP $16,000/annual Basic pay $6,258.60/mo $79,912.8 Housing $1,719/mo $20,628 BAS $223.04/mo $2,676.48 If generalist would be $164,717.04 MY PAY Subspecialist Training: Military or civilian residency (4) Fellowship (3) Commitments: USAFA(5) HPSP(4) Residency(3 concurrent) Sponsored fellowship 3 yrs after residency(3) Obligated or “Creditable service” – 19 years ADSC Only eligible for ISP, not MISP/MSP So, ASP/ISP will not push beyond 20-yr service mark Any MISP/MSP will be tacked on to end… i.e., >20 years Last 4 yrs of career: ISP($36k)x4 = $144k MY PAY IF I TRAINED AD FELLOWSHIP Subspecialist Training: Military or civilian residency (4) Fellowship (3) Commitments: USAFA(5) HPSP(4) Residency(3 concurrent) AD fellowship 3 yrs after residency(3 concurrent) Obligated or “Creditable service” – 16 years ADSC Eligible for ISP, and MISP/MSP starting at 16 years So, ASP/ISP and up to 4 year MISP/MSP will not push beyond 20-yr service mark Last 4 yrs of career: MISP/MSP($81k)x 4= $324k Doing a Civilian Sponsored Fellowship over AD cost me $324k- $144k=$180K!!! (Assuming I stay in to retirement) MY PAY IF I SKIPPED FELLOWSHIP General OB/GYN staying in for 20 Training: Military or civilian residency (4) Commitments: USAFA(5) HPSP(4) Residency(3 concurrent) Obligated or “Creditable service” – 13 years ADSC Eligible for ISP, and MISP/MSP starting at 13 years So, ASP/ISP and up to 7 year MISP/MSP will not push beyond 20-yr service mark Last 7 yrs of career: MISP/MSP($66k)x 7= $462k Doing a civilian sponsored fellowship over skipping fellowship and staying in for 20 years cost me $462k-($36k x 7 years)=$210K!!! Retirement Savings Thrift Savings Plan Federal equivalent to 401k Pretax dollars (Roth coming… 2012) No matching of contributions Limits No limit to % of income, consider each bonus separately IRS cap at $16,500 in 2010 Taxes Similar to traditional IRA Penalty for withdrawal before age 59 1/2 Resources http://tsp.gov FINANCES Let‟s assume they don‟t change retirement What is it worth? EXAMPLE OF MY RETIREMENT Assumptions Years Year Monthl Annual Cumulativ out y Pay Pay e Retire with 20 years 1 2021 5,365 64,382 64,382 Year 2021 Rank 0-5 10 2030 7,312 87,746 755,291 Would have to stay 21 years for 0-6 retire 20 2040 10,315 123,775 1,820,704 30 2050 14,550 174,596 3,323,573 40 2060 20,524 246,285 5,443,519 http://militarypay.defense.gov/Tools/index.html FINANCES: WHAT COULD I EXPECT TO MAKE OUTSIDE OF THE MILITARY? Average Generalist $250K Average MFM $394K Average REI $317K Average Onc $413K Average Uro gyn not available Many factors involved in pay such as practice type (academic vs private practice vs HMO), gender (females > male), location (urban vs rural) Most MISP/MSP pay differences would be negated after a couple years in practice as MFM/Onc/REI unless comparing well paying private generalist position and academic sub- specialist Source: Physician recruiters (CompHealth and InterimHealth) along with the American Medical Group Association OTHER CONSIDERATIONS Limited sites to practice for sub-specialites Sub-specialists typically at residency centers only Wider variety of practice locations as generalist Doing fellowship will commit you to more commitment! QUESTIONS?
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