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Fellowship Training

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

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Fellowship Training

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  1. Fellowship Training Maj Barton Staat

  2. 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

  3. 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

  4. 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)

  5. 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

  6. 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

  7. Air Force HPERB ResultsOB/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

  8. 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/

  9. Sponsored, Deferred or AD?Civilian Sponsored • You will be AD during civilian fellowship • Same pay as OB Staff (approximately twice what you would earn as a civilian fellow) • Minimal military obligations • (PT test, urine drug screen, medical and dental appt) • You owe one additional year for each year of sponsored training that will be served after other obligations • You will continue to progress in years of service • You will be eligible for promotion • Progress towards retirement • Some programs view sponsored as highly desirable (they can’t pay you/you are free labor)

  10. Sponsored, Deferred or AD? • Civilian Deferred • Rarely offered for fellowship training • Average pay for fellow $65K

  11. Sponsored, Deferred or AD? Active Duty • Staff pay • Continue to gain years towards promotion/retirement • Less choice in program selection • Additional commitment is served consecutively (IE if you have 4 years of HPSP obligation you would not owe more than the 4 already but if 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.

  12. When will I know about fellowship spots?

  13. What do I have to submit? • DOD Application • 2 page application • CV • Personal statement • Education summary • Other supporting documents • USMLE / COMLEX scores- Steps 1, 2 and 3 • Medical school records • Transcripts • Dean’s Letter (MSPE) • Program Director’s Interview sheet • Letters of recommendation • Current PD evaluation form • PD evaluation form from previous programs • Current fitness test score • Copy of unrestricted medical license (for trainees in year PGY3 or greater) • Current Interns, STEP 3

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. I was selected! Now what?

  20. 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

  21. 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)

  22. Civilian Fellowship links • MFM • https://www.smfm.org/MFM%20Fellowship%20Page.cfm • REI • http://www.socrei.org/uploadedFiles/Affiliates/SOCREI/Fellowships/REIFellowshipPrograms.pdf • Gyn-Onc • http://www.sgo.org/Membership/Resources_for_Candidates_and_Fellows/Fellowship_Programs/ • Urogyn • https://www.augs.org/Fellows/FellowsResources/tabid/212/Default.aspx

  23. 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?

  24. Military Pay (lots of acronyms!) Bonuses: • VSP • Board Certified Pay • ASP • ISP • MSP • MISP/MSP • ECISP

  25. Military Pay: VSP VSP • Variable Special Pay • “Pay for being a doctor” – Yes, even an intern • No commitment, no contract

  26. Military Pay:Board Certified Board Certified Pay • ABMS recognition • “Pay for being board certified doctor” • No commitment, no contract • So, by 22 yrs, you will lose $420/m VSP, and gain $290/m on board certified pay

  27. 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

  28. 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

  29. 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.

  30. 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 ** Consecutive **

  31. What do I make now? • Assumptions • Major • 10yr • Living in San Antonio • Has dependents • Board Certified • Sub-specialist • VSP $1000/mo • $12,000 • BCP $208.33/mo • $2,500 • ISP $36,000/annual • ASP $16,000/annual • 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

  32. What would I make as a generalist? • Assumptions • Major • 10 • Living in San Antonio • Has dependents • Board Certified • VSP $1000/mo • $12,000 • BCP $208.33/mo • $2,500 • ISP $31,000/annual • 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

  33. 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

  34. 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)

  35. 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!!!

  36. 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

  37. Finances • Let’s assume they don’t change retirement • What is it worth?

  38. Example of My Retirement • Assumptions • Retire with 20 years • Year 2021 • Rank 0-5 • Would have to stay • 21 years for 0-6 retire http://militarypay.defense.gov/Tools/index.html

  39. Finances:What could I expect to make outside of the military? • Average Generalist $250K • Average MFM $394K • Average REI $317K • Average Onc $413K • Average Urogyn 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

  40. 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!

  41. Questions?

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