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MEDCOM Updates

MEDCOM Updates. Christopher A. Dillon MD COL, MC Accessions/Recruiting Liaison to OTSG. Current Issues in Medical Education. Increase in Medical School Enrollment AAMC reports nearly 30% from 2002 80% of MD schools 75% initiatives encouraging primary care

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MEDCOM Updates

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  1. MEDCOM Updates Christopher A. Dillon MD COL, MC Accessions/Recruiting Liaison to OTSG

  2. Current Issues in Medical Education • Increase in Medical School Enrollment • AAMC reports nearly 30% from 2002 • 80% of MD schools • 75% initiatives encouraging primary care • 112th Congress Deficit Reduction • 60% reduction ($3.9B) in Medicare payments to teaching hospitals • ACGME concerned re: # trainees & education

  3. Current Issues in Medical Education • Control Act of 2011 • Eliminates interest subsidies on Stafford Loans • Graduate & Professional Students begin July 1, 2012 • Still have access to same amount of loans ($40,500 for medical students) • Since unsubsidized, estimates increase loan costs by $10,000-$20,000 per student • Physician Salaries • https://www.aamc.org/download/48732/data/compensation.pdf

  4. Current Issues in Medical Education • National Match • 2014- MD applicants will equal positions offered • GME slots up 6%/5 yrs but applicants up 9.5%/5 yrs • Only 52% of civilians got 1st choice • 14,000 non-U.S. senior applicants • Match will be more competitive (>900 U.S. senior medical students didn’t match last year) • Military Match • Smaller, better chance to match 1st or 2nd

  5. GRADUATE MEDICAL EDUCATION STATS • Number, specialty distribution, subspecialty options programmed to meet the needs of the Army. - 137 Programs 72 residencies, 59 fellowships, 6 transitional internships). - 22 Specialties. - 11 Teaching hospitals. - 57% of programs with 5 yr. accreditation; 20% with 4 yr. accreditation (3.95 yr is civilian average; Army average 4.3 yrs). • Majority of Army physicians in GME train in in-house programs. - 1466 in training (1355 in-house programs and 111 Army sponsored civilian training). 30 in educational delay/FAP. - Comprises 31% of active duty Medical Corps end strength. • 93% first time board pass rate.

  6. Army GME Success Stories • Brooke AMC and Walter Reed AMC General Surgery • Two of only 10 surgery programs in the country (250 programs total) to have a 100% first time pass rate on both written and oral boards over the last 5 years • Emergency Medicine • Residents at Darnall ACH, Brooke AMC and Madigan AMC have scored in the top 10 nationwide on the annual EM in-service exam for the past 11 years • Internal Medicine • WRAMC IM residents (13) achieved a 100% pass rate on the 2007 ABIM certification exam. The national average for first-time takers between 2002 and 2006 is 91%. The Walter Reed average for first-time takers for the past 10 years is 98%. • Ophthalmology • The Army had the first residency program in the US to get the virtual reality ophthalmic surgical simulator. 100% of our ophthalmology residency programs are sim-inclusive.

  7. Medical Research • The U.S. Army Aeromedical Research Laboratory (USAARL), Fort Rucker, Alabama • U.S. Army Institute of Surgical Research (USAISR), Fort Sam Houston, Texas • U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), Aberdeen Proving Ground, Maryland • U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland • U.S. Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts • Walter Reed Army Institute of Research (WRAIR), Forest Glen, Maryland • U.S. Army Dental Research Detachment • U.S. Army Medical Research Detachment • Armed Forces Research Institute of Medical Sciences-Thailand (AFRIMS) • U.S Army Medical Research Unit- Europe • U.S Army Medical Research Unit- Kenya

  8. Regional Medical CommandsTeaching Hospitals Walter Reed AMC Womack AMC DeWitt ACH Keller ACH (West Point) Eisenhower AMC Martin ACH Darnall AMC Brooke AMC William Beaumont AMC Madigan AMC Tripler AMC

  9. ARMY FIRST YEAR GRADUATE MEDICAL EDUCATION (FYGME) PROGRAMS - (PGY-1)

  10. Internal Medicine Family Medicine Emergency Medicine Pediatrics Obstetrics/Gynecology General Surgery* Neurosurgery Orthopaedics Urology Otolaryngology Preventive Medicine/ Occupational Medicine* Dermatology Radiology Radiation Oncology Anesthesiology Aerospace Medicine* Neurology and Child Neuro Pathology Psychiatry Physical Medicine and Rehabilitation Ophthalmology Residencies * Specialty does not offer continuous contract; must reapply for PGY-2 year.

  11. Emergency Medicine Family Medicine General Surgery Internal Medicine Neurology Neurosurgery OB-GYN Orthopaedics Otolaryngology Pathology Pediatrics Psychiatry PGY-1 Categorical Specialties

  12. Designated Preliminary/Pre-Select Specialties • General Surgery* • Urology • Transitional Year • Undesignated • Designated • Aerospace Medicine* • Anesthesiology • Dermatology • Ophthalmology • Physical Medicine • Preventive Medicine/Occupational Medicine* • Radiation Oncology • Radiology (Diagnostic) * Specialty does not offer continuous contract; must reapply for PGY-2 year.

  13. Applications For FYGMEApplicants Per Approved Positions

  14. Applications For FYGME (continued)Applicants Per Approved Positions

  15. VA-DoD Training Opportunities • Intern year in Army program • Remainder of residency in VA-sponsored program • Radiology – Medical College of Georgia; UT San Antonio • Urology – UT San Antonio; Duke University • Neurosurgery* – University of Florida; UT San Antonio *Entirety of training in VA-sponsored program

  16. 2010 Army GMESB Selection Summary Report Fellowship Training

  17. Fellowships 2012

  18. Fellowships 2012

  19. Fellowships 2012

  20. Fellowships 2012

  21. Fellowships 2012

  22. HPSP • 80% of all active duty physicians • Full assistance (tuition, books, equipment and monthly stipend of $2,088) • Available to: physicians, dentists, veterinarians, clinical psychologists, pharmacists and optometrists • Reasons to take scholarship • Debt free after med school (avg. debt is $160,000) • GME opportunities and subspecialty training • Unlimited practice opportunites in

  23. Reasons to Apply for HPSP • Debt free after Medical school+ $20k bonus • Median education debt is $160,000 • Outstanding GME opportunities in Army programs and subspecialty training • Unlimited practice opportunities in academic, operational, clinical medicine and research • Excellent benefits while on AD and retirement* • Selfless service

  24. HPSP

  25. HPSP Changes • MAC (Minimal Acceptance Criteria): • GPA >/= 3.2 undergrad • MCATs >/= 24 with no score <8 • AAC (Automatic Acceptance Criteria): • NO LONGER • Average MCAT for HPSP matriculants is 29.3 and average GPA is 3.62 • Waivers: 103 requests, 19 approved • Virtually all approved were for combined programs

  26. More HPSP Notes • Residency Competition for Army will peak in 2012-2013 • Most scholarships are 4 years • 3-year scholarships mostly rollovers • HPSP students expected to take BOLC after 1st year medical school • 2nd year prepare for part 1 of boards • 3rd and 4th years to ADT at Army hospitals

  27. HPSP Plan of Attack • New Approach • USAREC and MEDCOM working together • Adjustments in requirements • Improvement in Quality

  28. Attrition Rates YearOverallAcademic 2007 5.4% 1.7% 2008 4.6% 3.3% 2009 6.4% 4.7% 2010 4.0% 3.1% 2011 3.2% 1.2% National 4.0% 1.4%

  29. HPSP Plan • Target: • Undergraduate universities • Universities with large number of medical school matriculants • Universities with large number of matriculants to out-of-state and private medical schools • Pre-health clubs, Medical Honor societies, advisors & ROTC • Target financial aid advisors at medical schools and staff with access to accepted students • Provide SME at all events involving at least major universities (Top 65) • Provide regular training to recruiters from GME and deliver readily available POC • Provide visibility to leaders and AARs

  30. Same for Civilian and Army** Medical Professional Career Tracks • Clinical • Academic • Research • Operational • Multiple Levels of Hooah! • Command – Leadership • Corporate Level Management Army Unique

  31. Life Cycle Model Is: • Integration of Professional Medical Education and Professional Military Education as the three pillars of leader development: -Military training/GME -Self development -Operational assignments • Designed to provide guidelines for completion of courses, career integration at specific ranks and career points • http://www.army.mil/usapa/epubs/xml_pubs/p600_4/head.xml

  32. FYGME RESIDENCY FELLOWSHIP Medical Corps Officer Career Progression YEARS 0 30 6 18 12 CPT MAJ COL LTC Rank BOLC CCC INTERMEDIATE LEVEL ED SENIOR SVC. COLLEGE Professional Military Education CBRNE SHORT COURSES Additional Training EXECUTIVE SKILLS COURSE ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT MPH MBA TWI ADVANCED SCIENCE DEGREE DEVELOPMENTAL & UTILIZATION ASSIGNMENTS Corps/MACOM Surgeon Commander Joint Assignments DCCS MECEN Staff Deputy Chief Dir Med Ed USUHS Faculty Department Chair Research Area Dir. BN/BDE/DIV Surgeon MEDCOM Staff DCCS MEDCEN Staff MEDDAC Staff Residency Director Product Line Mgr Division Chief Clinician Successful Completion of Fellowship TOE/TDA Physician Company Commander Clinic OIC Teaching Staff Research Assistant Clinician Successful Completion of Internship and Residency Utilization Tour Clinician Typical Assignments Self Development Continuing Medical Education / Board Recertification License by yr. 2 Board Certification Subspecialty Board Certification

  33. LeadershipOpportunities • An Army Officer • Training and mentoring junior soldiers/physicians in your specialty. • Opportunities to lead sooner than civilian practices • Your professional recommendations are more valued, and you have the autonomy within your practice without third-party interference • Full-spectrum of leadership opportunities from service/department chief to Surgeon General

  34. The “Right” Career? • 4300 career “rabbit paths” • Clinical competence is paramount • Meet the requirements • Stack the deck in your chosen path • Assignments • Schools • “A” designator • OER Support Forms • Understand the consequences and accept responsibility

  35. Retention • MC Retention Issues • Deployment / Family • Length of deployment • Down to 4.5 months for physicians • AHLTA/admin issues • Initial ADSO Retention FY11=70% • FY10 = 63% • FY09 = 59% • 57% - 65% over the past 5 years • Continuation rate beyond initial ADSO > 90%

  36. OEF/OIF: Rapid Integration of Lessons Learned • Force Health Protection • Behavioral Health • Interventions to Enhance Psychological Resilience and Prevent Psychiatric Casualties. • Pentagon Post-Disaster Health Assessment • PTSD • Immunizations • Vaccine Healthcare Centers Network (VHC) • Myocarditis and Oral Vaccine with Smallpox Vaccine • Battlefield Medicine • Training of Medics: 91W • Use of Blood Transfusions, Whole Blood, Factor VII • Hemostasis: Tourniquets and HemCon Bandages • Pain Control & Regional Anesthesia: pain pumps • Home Station/Garrison Care • Amputee Care & Rehabilitation: Intrepid Center • Deployment Health Practice Guideline • Community Based Warrior Transition Unit: CBWTU • Traumatic Brain Injury (TBI)

  37. Battlefield Survival • Forward surgical/resuscitation capabilities • Advanced evacuation capabilities • Body Armor • Advanced surgical techniques • Advances in antibiotic tx

  38. Transforming for Success Survivability (%) WWII ODS SOMALIA OEF OIF Survivability = 100% - (KIA% + DOW%)

  39. Army Medicine Serving the nation since 1775 China 1944 44th MASH, Korea 1954 Radiology residents 1968

  40. The Army’s Home for Health… Saving Lives and Fostering Healthy and Resilient People ~ Partnerships Built on Trust

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