NAVY MEDICINE UPDATE For Navy ACP

1. NAVY MEDICINE UPDATE For Navy ACP Christopher M. Culp, MD, FACP CAPT, MC, USN Commanding Officer Naval Hospital Bremerton

2. “This has been a challenging year, marked by end strength reductions, operational demands, recruiting difficulties, financial constraints and increasingly onerous regulation, particularly of our GME programs…”

3. “This has been a challenging year, marked by end strength reductions, operational demands, recruiting difficulties, financial constraints and increasingly onerous regulation, particularly of our GME programs…” Medical Corps Update, Fall 1996

4. Issues Abound • PERS is broke • Navy is broke • Big Navy taking on water and a dysfunctional Congress threatens to make matters even worse • SERBs for the line – 129 Line O5/O6 • Navy Medicine so far immune (problem) • Life under a CR is PAINFUL – and coming!!

5. Current Environment FY12 Budget not approved • House passed, Senate action remains • FY12 CR almost certain for 3 months or longer; 2-week intervals likely FY13 Service budgets submitted to OSD at end of July, but: • Debt ceiling struggle changed landscape • Assumptions that Services built into budgets in doubt given demands / requirements for less spending • OMB / OSD senior officials reworking budget approach on policy level, to include strategy & entitlements / benefits (“everything on table”) •  Driving uncertainty / stability concerns at field activities

6. Fiscal Issue – Example Federal spending for FY2011: • a. revenue: $2,170,000,000,000 • b. Federal spending: 2011: $3,820,000,000,000 • c. deficit: $ 1,650,000,000,000 • d. National debt: $14,271,000,000,000 • e. Recent budget "cut": $ 38,500,000,000 (about 1% of the budget) Remove 8 zeros from these numbers: • a. Total annual income: $21,700 • b. Amount of money spent: $38,200 • c. Amount of new debt added to the credit card: $16,500 • d. Outstanding balance on the credit card: $142,710 • e. Amount cut from the budget: $385 $385 cut against $16,500 in deficit spending with $142,710 owed. FOR OFFICIAL USE ONLY

7. Next Steps Congressional Super Committee has been named By 23 Nov must come up with $1.2T reductions • Spaced over 12 years • Congress must approve or provide alternative by 23 Dec • Automatic enforcement if no agreement  sequestration • Exempts: federal civilian and military retirement, SS, Medicare Last Month: OMB directed 5% / 10% below FY11 appropriated levels as ‘new’ levels for FY13 • OSD Comptroller working this with the Services • No changes yet for DHP

8. Wartime…But Whose War??? • Not the Blue Water Navy • Not Surface, Air or Sub…. • Marines and anyone who supports them • Special Ops / EOD / SEALs • Navy Medicine – particularly primary care and surgical specialists

9. NCIS Counterintelligence Brief | UNCLASSIFIED

10. Wartime…But Whose War??? • Not the Blue Water Navy • Not Surface, Air or Sub…. • Marines and anyone who supports them • Special Ops / EOD / SEALs • Navy Medicine – particularly primary care and surgical specialists

11. At War and Under Pressure • We thus remain at war, in primary support of a “sister service” and as a joint asset with our resource sponsor under extreme pressure

12. Chief of the Corps RADM Matthew Nathan Commander, Navy Medicine NCA Commander, National Naval Medical Center, Bethesda

13. Chief of the Corps RDML William M. Roberts Fleet Surgeon, United States Fleet Forces Command Interim Corps Chief pending SG confirmation

14. M00C1 Staff • CAPT Roos Deputy Chief of Corps • CAPT Chun Career Planner • CAPT Greenhalgh Plans & Policy ** Deployed** • CAPT Marrese Reserve Affairs • LCDR Baldwin* Recruiting Fellow * Detached summer 2010

15. Medical Corps Stats(as of 30 AUG 2011) • Total Officers 3902RC 561 • Staff 2829 561 • Training 1073 0 • Funded Billets 3808RC 707 • Staff 2775 • Training 1053 • MC Manning 102.5% (+96) RC 79% • NSPS/GS + Contract 190 + 360 (>14% of force) World Class Care…Anytime, Anywhere

16. Medical Corps Stats(As of March 2011) • Total Officers 3730 • Staff 2687 • Training 1043 (-30) • Funded Billets 3806 • Staff 2753 • Training 1053 • MC Manning 98.0% (-76) • NSPS/GS + Contract 190 + 360 (>14% of force) World Class Care…Anytime, Anywhere

17. MC BY YEARS OF SERVICE HPSP Under-fill

18. Medical Service Corps missed direct goal FY04-06 Suppressed Accessions YCS

19. MC BY YEARS OF SERVICE

20. Manning by SpecialtySeptember 2011 Heavily Tasked for OIF/OEF 1. Prev Med 15. FS 2. UMO 16. Pathology 3. RAM 17. IM 4. Derm 18. Neurosurg 5. Urology 19. Occ Med 6. G Surg 20. ENT 7. Radiology 21. Rad Onc 8. Fam Med 22. Ophthalmol 9. Anesth 23. Peds 10. Psych 24. GMO 11. ER 25. Neurology 12. Ortho 26. PM&R 13 OB/GYN 14. Nuc Med

21. Endangered Species List by Corps (as of SEP 2011)

22. Projected Specialty Manning(in year of graduation for R2 class beginning July 2011)

23. Exit Pathways--MCShift Away from Reserves

24. RC Medical Corps Attrition Inventory to OPA Most Critical Specialties Retention Incentives • SSP Inventory/Authorized – FEB 2011 • Orthopedic Surgery – 35% (17/49) • Anesthesiology – 50% (36/71) • General Surgery – 55% (55/101) • Psychiatry – 68% (17/25) • Family Medicine – 81% (59/73) • Emergency Medicine – 80% (41/51) • Neurosurgery – 90% (9/10) • When on active duty (AT, Mobilized*) SELRES Medical Corps Officers receive the same special pays authorized by AC Medical Corps Officers. (ISP, VSP, ASP, BCP) with one or two exceptions. • There does not currently exist a special/incentive pay intended to retain Medical Corps officers in a drilling status, although one was planned for 15H (Ortho Surg) in an upcoming FY * Can only involuntarily deploy once over 5 year period

25. Where We Are • HPSP Under-recruit • Ongoing theater demands • Sequential lean years • Increasing demands for training billets GMESB 2011: 57 days →

26. HPSP Goal vs Accessions

27. HPSP Under-fill

29. Minimum number of graduates needed to meet annual operational medical officer (GMO+FS+UMO) requirements Minimum number of graduates needed to meet annual operational requirements + meet inservice GME-2 program selection goals Minimum number of graduates needed to meet operational requirements + meet inservice GME-2 program selection goals + defer appropriate number of graduates to train in critical shortage specialties

30. Timeline after 4 year HPSP Underfill

31. Timeline after 4 year HPSP Underfill

33. Timeline after 4 year HPSP Underfill

34. Timeline after 4 year HPSP Underfill

35. Timeline after 4 year HPSP Underfill

36. NADDS and FAP Grads (past and in pipeline) Missing HPSP grads Graduation year MEDICAL STUDENTS GRADUATE GMO’S (FS/UMO/USMC/SWMDO) GME TO NAVY INSERVICE TRAINING AND APPROX 70/YEAR INTO THE NADDS DELAY SPECIALTY PROGRAMS (THESE ARE THE OUTPUTS THAT WILL DISAPPEAR STARTING IN FY12)

37. Projected Specialty Manning(in year of graduation for R2 class beginning July 2010)

38. Mitigation • 371 total deficit over 4 consecutive years • 20-25 Direct Accessions per year • FAP limited • War demands ongoing • PERS under extreme fiscal pressure • Hold 2011 GMESB in Hotel with BAR

39. First – Recruit Well

40. 2nd – Retain Very Well • Promotion opportunity (at historic peak) • End of career waivers • Age 62 (NDAA change to 68 pending) • Continuation beyond 30 years (not ret/ret) • Pay stability • Practice climate • ***It’s Working!!

41. New FY09 MC Special Pay Rates FY10 Change: Aerospace Medicine to $13k/$19k/$25k

42. Internist Pay

43. Alternative Accessions Programs • Civilian Match • HSCP • No tuition / books / equipment • AD (E6) pay & allowances • 4-year obligation on supercession to LT • Some administrative drawbacks • Increased FAP

44. Promotions

45. MC Promotion to Control Grades Active Component 2100 FY 09 FY 10 FY 11

46. Promotion to Control Grades Medical Corps Reserve (2105) FY 10 FY 11 FY 12 Proposed

47. Medical Corps Promotion Selection & Opportunity FY03- FY11