MEDCOM Updates Christopher A Dillon MD COL MC

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

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 • 112 th Congress Deficit Reduction § 60% reduction ($3. 9 B) in Medicare payments to teaching hospitals § ACGME concerned re: # trainees & education 2

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 3

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 1 st 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 1 st or 2 nd 4

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. 5

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 firsttime 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. 6

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 7

Regional Medical Commands Teaching Hospitals Walter Reed AMC Eisenhower AMC William Beaumont AMC Womack AMC Martin ACH Madigan AMC De. Witt ACH Darnall AMC Tripler AMC Keller ACH (West Point) Brooke AMC 8

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

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

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

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

Applications For FYGME Applicants Per Approved Positions SPECIALTY (#slots 2011) 2006 2007 2008 2009 2010 2011 Emergency Medicine (28) 1. 25 1. 23 1. 63 1. 15 1. 14 1. 36 Family Medicine (44) 1. 09 0. 80 0. 58 0. 56 0. 88 1. 07 General Surgery (26) 1. 29 1. 10 0. 92 1. 65 1. 84 1. 65 GS Neurosurgery (3) 0. 50 1. 00 7. 00 1. 50 1. 33 GS Urology (7) 1. 57 1. 00 1. 17 1. 57 0. 71 Internal Medicine (58) 0. 84 1. 06 0. 75 0. 65 0. 71 0. 66 Neurology (6) 1. 20 0. 60 0. 33 1. 20 0. 50 0. 83 Child Neurology (1) 0. 00 1. 00 OB-GYN (17) 1. 53 1. 13 1. 20 0. 59 0. 83 Orthopaedics (19) 1. 36 1. 95 1. 84 1. 47 0. 89 1. 21 Otolaryngology (7) 1. 28 4. 00 1. 14 1. 00 1. 71 1. 33 Pathology (6) 1. 16 0. 50 1. 17 1. 00 1. 17 Pediatrics (26) 1. 20 0. 88 0. 92 0. 62 0. 92 Psychiatry (15) 0. 83 1. 07 0. 64 0. 71 0. 87 0. 88 13

Applications For FYGME (continued) Applicants Per Approved Positions SPECIALTY (#slots 2011) 2006 2007 2008 2009 2010 2011 Psychiatry/Internal Medicine (0) 0. 50 1. 50 2. 00 0. 00 Transitional (15) 0. 27 0. 06 0. 20 0. 13 Prelim Aerospace Medicine (1) 0. 50 0. 00 1. 00 0. 00 Prelim Anesthesiology (12) 1. 33 1. 42 1. 25 1. 50 0. 83 1. 25 Prelim Dermatology (7) 1. 62 1. 29 0. 57 1. 29 0. 71 Prelim Ophthalmology (7) 1. 42 1. 14 0. 72 1. 57 0. 86 0. 43 Prelim Physical Medicine (3) 1. 66 2. 00 3. 33 1. 00 1. 33 2. 00 Prelim Preventive Medicine (2) 0. 25 0. 67 0. 75 0. 50 1. 00 Prelim Radiation Oncology (1) 2. 00 0. 00 2. 00 1. 00 0. 00 1. 00 Prelim Radiology (Diag) (15) 1. 25 1. 00 1. 67 1. 00 0. 87 14

VA-Do. D Training Opportunities • • Intern year in Army program Remainder of residency in VAsponsored 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 15

2010 Army GMESB Selection Summary Report Fellowship Training Selects Inservice Military Selects Deferred Selects Civilian Sponsored Total Applicants Inservice Select Rate Overall Select Rate Total Selects Non. Selects Utilization/ Field 46 0 26 72 23 95 48% 76% Interns 0 0 0 0% 0% Current Deferred 1 0 0 1 6 7 14% Current Residents 30 0 29 59 57 116 26% 51% Civilian 1 0 0 1 2 3 33% Totals 78 0 55 133 88 221 35% 60% Female 19 0 10 29 22 51 37% 57% Minorities 21 0 12 33 26 59 36% 56% Totals 40 0 22 62 48 110 36% 56% 16

Fellowships 2012 Aerospace Med Hyperbaric Med CIV 1 Anesthesiology Acute Pain/Regional Anesth NCC 1 Critical Care Anesth NCC 1 Pain Management NCC 2 Pediatric Anesth CIV 1 Dermatology Dermatologic Surgery CIV 1 Emergency Med Wilderness Med MAMC 1 Emergency Med Cardiology CIV 1 Emergency Med Services SAUSHEC 1 Emergency Toxicology CIV 1 Pediatric Emergency Med CIV 1 Sports Med CIV 1 Ultrasound SAUSHEC/MAMC/Darnell 3 Faculty Development MAMC 3 GI/Colonoscopy MAMC 1 Hospitalist CIV 1 OB/GYN Darnall/CIV 2 Sports Med NCC/CIV 3 General Surgery Plastic Surgery CIV 2 Other Surgery Advanced Laproscopy CIV 3 Trauma/Critical Care Surgery SAUSHEC/CIV 2 Family Medicine 17

Fellowships 2012 Internal Medicine CIV 1 SAUSHEC 1 Endocrinology NCC 1 Gastroenterology SAUSHEC(3)/NCC(2) 5 GI Invasive Endoscopy CIV 1 General Internal Med WBAMC 1 Hematology/Oncology SAUSHEC(1)/NCC(2) 3 Infectious Diseases SAUSHEC(2)/NCC(1) 3 Nephrology NCC 1 Pulmonary/CCM SAUSHEC(1)/NCC(2) 3 Rheumatology NCC 1 Child Neurology NCC 1 Clinical Neurophysiology NCC 1 Headache Medicine CIV 1 Neuro Critical Care CIV 1 Maternal and Fetal Medicine MAMC/CIV 2 Gyn Minimally Invasive Surgery NCC 1 Reproductive Endocrinology Ophthalmology 5 Critical Care Med OB/GYN SAUSHEC(2)/NCC(3) Cards Interventional Neurology Cardiology NCC/CIV 2 Glaucoma CIV 1 Ophthalmic Pathology CIV 1 Retinal Surgery CIV 2 18

Fellowships 2012 Orthopedics Keller 2 NCC 2 Orthopedic Trauma CIV 2 Shoulder Surgery CIV 1 Spine Surgery CIV 2 Total Joint/Recnstructive Surg CIV 1 Facial/Plastic/Reconstruct Surg CIV 1 Head and Neck Surgery CIV 2 Pediatric Otolaryngology CIV 1 Sleep Med and Surgery CIV 1 Clinical Molecular Genetics CIV 1 Forensic Pathology AFIP 1 Neuro Pathology CIV 1 Pathology Infomatics Pediatrics 1 Hand Surgery Pathology CIV Feagin Sports Med Otolaryngology Childrens Ortho CIV 1 Developmental Peds MAMC 2 Neonatology SAUSHEC(1)/NCC(1) 2 Pediatric Cardiology CIV 1 Pediatric Endocrinology NCC(1)/CIV(1) 2 Pediatric Gastroenterology NCC 1 Pediatric Infectious Diseases NCC 1 Pediatric Pulmonary CIV 1 19

Fellowships 2012 Physical Medicine Pain Management NCC 2 Prevent/Public Health Medical Toxicology CIV 1 Occupational Medicine NCC 2 Preventive Medicine NCC 1 Addiction Psychiatry TAMC 1 Child/Adolescent Psych TAMC(3)/NCC(3) 6 Forensic Psychiatry NCC 1 Preventive Psychiatry NCC 1 Psychosomatic/Geriatric Psych NCC 1 Musculoskeletal Imaging CIV 3 Neuroradiology CIV 1 Trauma Radiology SAUSHEC 1 Vascular/Interventional Rad CIV 1 Stone/Laproscopy Disease CIV 1 Trauma/Reconstructive Uro CIV 1 Adolescent Medicine SAUSHEC 1 Allergy NCC 3 Clinical Pharmacology WRAIR 2 Clinical Research SAUSHEC 2 Critical Care Ultrasound SAUSHEC 1 Geriatric Medicine MAMC 2 Medical Genetics CIV 1 Nuclear Medicine NCC 2 Sleep Disorders SAUSHEC(3)/NCC(2) 5 Psychiatry Radiology Urology Specialty Immaterial 20

Fellowships 2012 Degree Programs Epidemiology USUHS 1 Medical Information Systems MAMC 1 147 Leadership Develop. Health Care Admin CIV 2 Health Care Admin-Baylor CIV 2 21

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

Reasons to Apply for HPSP • Debt free after Medical school+ $20 k 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 23

HPSP MODEL Scholarship Length YEAR OUTPUT 1 YR 2 YR 3 YR 4 YR 11 12 13 14 15 10 0 30 255 INPUT 295 2010 232 283 324 300 255 TOTAL 1162 5 0 30 255 INPUT 290 2011 283 329 300 285 255 TOTAL 1169 0 0 20 255 INPUT 275 2012 329 300 285 275 255 TOTAL 1115 0 0 20 255 INPUT 275 2013 300 285 275 255 TOTAL 1090 0 0 20 255 INPUT 275 2014 285 275 275 255 TOTAL 1080 0 0 20 255 INPUT 275 2015 275 275 255 TOTAL 1080 0 0 20 255 INPUT 275 2016 275 275 255 TOTAL 1080 0 0 20 255 INPUT 275 2017 275 275 255 TOTAL 1080 0 0 20 255 INPUT 275 2018 275 275 255 TOTAL 1080 0 0 20 255 INPUT 275 2019 275 275 255 TOTAL 1080 0 0 20 255 INPUT 275 2020 275 275 255 TOTAL 1080 MAX 24

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 25

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 1 st year medical school § 2 nd year prepare for part 1 of boards § 3 rd and 4 th years to ADT at Army hospitals 26

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

Attrition Rates Year Overall Academic 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% 28

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 29

STATE University Location AL Oakwood College Huntsville AZ U. of Arizona Tucson Arizona State U. Tempe UCLA Los Angeles UC Berkeley UC San Diego La Jolla UC Irvine UC Davis Stanford U. of Southern Calif. Los Angeles CO U. of Colorado Boulder CT Yale New Haven DC Howard U. Wash DC FL U. of Florida Gainesville U. of Miami Coral Gables u. OF South Florida Tampa Florida State U. Tallahassee U. of Central Florida Orlando Florida International U. Miami U. of Georgia Athens Emory U. Atlanta Spelman College Atlanta Morehouse College Atlanta X Georgia State U. Atlanta X U. of Illinois Champaign GA IL Afr. Am. CA Top MD Hispanic Top DO Asian LEGEND Top 10 Next 11 -20 Next 21 -30 Next 31 -40 Next 41 -47 30

STATE University Location Top MD Afr. Am. Top DO Hispanic Asian Northwestern U. Chicago U. of Notre Dame LEGEND Indiana U. Bloomington Top 10 Next 11 -20 Next 21 -30 Next 31 -40 LA Chicago Loyola U Chicago IN Evanston U. of Illinois Chicago Next 41 -47 Baton Rouge Xavier U. MA Louisana State U. New Orleans Harvard U. Cambridge Boston U. Boston Johns Hopkins U. Baltimore U. of Maryland College Park U. of Michigan Ann Arbor Michigan State U. Lansing MN U. of Minnesota Mineapolis MO Washington U. St. Louis NC Duke U. Durham U. of North Carolina Chapel Hill NJ Rutgers U. New Brunswick NM U. of New Mexico Albuquerque NY Cornell U. Ithaca New York U. New York Columbia U. New York Stony Brook U. Stony Brook MD MI 31

STATE University Location Top MD Afr. Am. Top DO Hispanic Asian OH U. of Oklahoma Norman PA Penn State U. University Park U. of Penn Philadelphia RI Brown U. Providence TN Vanderbilt U. Nashville TX U. of Texas Austin Baylor U. Waco U. of Texas Pan American Edinburg Texas A&M College Station U. of Texas San Antonio UT BYU Provo VA U. of Virginia Charlottesville Hampton U. Hampton Virginia Polytech LEGEND Top 10 Next 11 -20 Next 21 -30 Next 31 -40 Next 41 -47 Columbus OK Ohio State U. Blacksburg WA U. of Washington Seattle WI U. of Wisconsin Madison PR U. of Puerto Rico-Rio Pedras U. of Puerto Rico-Mayaguez U. of Toronto Can. 32

Army Unique Medical Professional Career Tracks • • • Clinical Academic Research Same for Civilian and Army** • Operational • Multiple Levels of Hooah! • Command – Leadership • Corporate Level Management 33

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/p 600_4/he ad. xml 34

Medical Corps Officer Career Progression YEARS 0 Rank 6 CPT MAJ BOLC CCC INTERMEDIATE LEVEL ED Professional Military Education Additional Training FYGME RESIDENCY 30 18 12 LTC COL SENIOR SVC. COLLEGE FELLOWSHIP CBRNE SHORT COURSES EXECUTIVE SKILLS COURSE ADV. TRAUMA MANAGEMENT, ADV. TRAUMA LIFE SUPPORT, COMBAT CASUALTY MGT MPH MBA TWI ADVANCED SCIENCE DEGREE DEVELOPMENTAL & UTILIZATION ASSIGNMENTS Typical Assignments Self Development Successful Completion of Internship and Residency Utilization Tour Clinician Successful Completion of Fellowship TOE/TDA Physician Company Commander Clinic OIC Teaching Staff Research Assistant Clinician BN/BDE/DIV Surgeon MEDCOM Staff DCCS MEDCEN Staff MEDDAC Staff Residency Director Product Line Mgr Division Chief Clinician Corps/MACOM Surgeon Commander Joint Assignments DCCS MECEN Staff Deputy Chief Dir Med Ed USUHS Faculty Department Chair Research Area Dir. Continuing Medical Education / Board Recertification License by yr. 2 Board Certification Subspecialty Board Certification 35

Leadership Opportunities • • An Army Officer • • Opportunities to lead sooner than civilian practices • Full-spectrum of leadership opportunities from service/department chief to Surgeon General Training and mentoring junior soldiers/physicians in your specialty. Your professional recommendations are more valued, and you have the autonomy within your practice without thirdparty interference 36

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

Retention • MC Retention Issues § Deployment / Family § Length of deployment – Down to 4. 5 months for physicians § AHLTA/admin issues • Initial ADSO Retention FY 11=70% § FY 10 = 63% § FY 09 = 59% § 57% - 65% over the past 5 years • Continuation rate beyond initial ADSO > 90% 38

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: 91 W § Use of Blood Transfusions, Whole Blood, Factor VII § Hemostasis: Tourniquets and Hem. Con 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) 39

Battlefield Survival • Forward surgical/resuscitation capabilities • Advanced evacuation capabilities • • Body Armor • Advances in antibiotic tx Advanced surgical techniques 40

Transforming for Success Survivability (%) WWII ODS SOMALIA OEF Survivability = 100% - (KIA% + DOW%) OIF 41 41

Army Medicine Serving the nation since 1775 China 1944 44 th MASH, Korea 1954 Radiology residents 1968 42

The Army’s Home for Health… Saving Lives and Fostering Healthy and Resilient People ~ Partnerships Built on Trust 43