Transcript 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
 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

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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 NCCWalter 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/

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

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)
SPONSORED, DEFERRED OR AD?

Civilian Deferred
Rarely offered for fellowship training
 Average pay for fellow
$65K

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.
WHEN WILL I KNOW ABOUT FELLOWSHIP
SPOTS?
Mid June
HPERB
releases
results
Sept 15th
JSGMESB
application
due
Mid Dec
JSGMESB
results
released
WHAT DO I HAVE TO SUBMIT?

DOD Application







USMLE / COMLEX
scores- Steps 1, 2 and 3
Medical school records




2 page application
CV
Personal statement
Education summary
Other supporting
documents
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
WHAT IF I WAIT UNTIL I’M STAFF?

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
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
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

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‘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

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
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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
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Preclinical med school performance
Clinical med school performance
Internship
Residency
Operational tour
Potential for success
Bonus points

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Research
Prior service
WHAT CAN I DO TO BOOST MY SCORE?


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Up to 4 points can be awarded for research
Each scoring panel determines their criteria for
awarding research points
Sample guidelines
One poster / abstract
 Two or more
 Single pub (peer reviewed)
 Multiple pubs


1 point
2 points
3 points
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?
Dec 2011 You
Matched!
Apply
Spring/Summer
2012
Interview
Summer/Fall
2012
Match Oct 2012
Start Fellowship
July 2013
TIPS TO BETTER YOUR CHANCES OF
GETTING SELECTED
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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.


Explain what civilian sponsored means

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Most fellowship directors are required to attend the specialty
meeting ASRM, SGO, SMFM , AUGS
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
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REI

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http://www.socrei.org/uploadedFiles/Affiliates/SOCREI/
Fellowships/REIFellowshipPrograms.pdf
Gyn-Onc


https://www.smfm.org/MFM%20Fellowship%20Page.cf
m
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
Grade 3
<6
Intern
≥8
<10
≥ 10
<12
≥ 12
<14
≥ 14
<18
≥ 18
<22
≥ 22
$1000
$958.33
$916.66
$833.33
$750
$666.66
$583.33
$100
$416.66
Thru 06
Above
06
≥6
<8
$583.33
MILITARY PAY:BOARD CERTIFIED
Board Certified Pay
– ABMS recognition
– “Pay for being board certified doctor”
• No commitment, no contract
Pay
Grade
All
Under
10
208.33
≥ 10
< 12
≥ 12
< 14
≥ 14
< 18
$291.66
$333.33
$416.66
≥ 18
$500
– So, by 22 yrs, you will lose $420/m VSP, and
gain $290/m on board certified pay
BONUS SYSTEM
ASP

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
Additional Special Pay
“Pay to retain you as a physician post residency”
Pay period:
Upon GME graduation
 typically 1 Jul – 30 Jun
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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
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
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 **
MISP

2
3
4
Gener
al
$31k
$17k
$25k
$35k
Subs
$36k
$21k
$31k
$45k
WHAT DO I MAKE NOW?
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Assumptions

Major

10yr
Living in San Antonio

Has dependents

Board Certified

Sub-specialist

VSP $1000/mo

BCP $208.33/mo


$79,912.8
Housing $1,719/mo
$20,628
BAS $223.04/mo


$2,500
ISP $36,000/annual
ASP $16,000/annual
Basic pay $6,659.40/mo


$12,000
2,676.48
$169,717.04
WHAT WOULD I MAKE AS A GENERALIST?
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Assumptions
Major
10
Living in San Antonio
Has dependents
Board Certified

VSP $1000/mo


BCP $208.33/mo




$20,628
BAS $223.04/mo


$79,912.8
Housing $1,719/mo
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
$2,500
ISP $31,000/annual
ASP $16,000/annual
Basic pay $6,258.60/mo


$12,000
$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:
Commitments:
Military or civilian residency (4)
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

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

Limits


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
Federal equivalent to 401k
Pretax dollars (Roth coming… 2012)
No matching of contributions
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
Years Year
out
Monthl
y Pay
Annual
Pay
Cumulativ
e
1
2021
5,365
64,382
64,382
10
2030
7,312
87,746
755,291
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
Assumptions
 Retire with 20 years
 Year 2021
 Rank 0-5
 Would have to stay


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 subspecialist
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?