Editor's Note: CDR(s) Thoemke's excellent FITREP guidance is reprinted here with his permission

Navy PAs have had a reasonable promotion board track record overall, relative to other MSC subspecialties. However, there are still many of us doing great things that struggle around promotion time. The feeling of not selecting, especially when you have worked extremely hard, can be deflating and demotivating. It was just a few years ago that I found myself scratching my head as several PAs were unsuccessful in selecting for promotion come board time. Some of them I knew well, some with advanced education beyond PA school, with good mix of tours, all superb officers, and all very intelligent, solid leaders. So, what happened? I get frustrated - frustrated for them, frustrated with the Navy, frustrated with the system. On the other hand, I also know many non-PA MSCs out there who are also doing great things. The MSC community we belong to is solid and pretty competitive -- and it should be. This may be uncomfortable to read, but, at the end of the day, our career is our own responsibility. So what do we need to do as PAs in this MSC world to stand out and promote?

Much of it has to do with both our planning and our writing ability. Understand the big picture. A recurring theme I have consistently heard is “We work harder than most by far and deserve to be promoted.” Without a doubt! In the following paper, I have tried to lay out some guidance I’ve collected from mentors and successful leaders, as well as what I have experienced myself over the years that have helped me. I have had the opportunity to write and read over many PA and other MSC FITREPs, OSRs, PSRs, etc. and have found a few recurring themes.

1. We are notoriously poor writers. We sell ourselves short by placing greater emphasis on the wrong items or by not highlighting the leadership and impact we do provide.
2. We focus too much on being really great and hard-working clinicians but fall short on other very important items like direct leadership and quantifiable impact.

If this is hard to understand, may I suggest that you consider changing your perspective? Look at the purpose of promotion in general. Promotion may feel like it is a reward for hard work, but it is not. The Navy promotes officers based on our potential to lead at higher levels of responsibility. In our commissioning, we are granted the authority and the responsibility to lead. If you fail at demonstrating this to the maximum of your potential through your career, the Navy will not likely promote you, regardless of how hard you work. The fitness report is the primary way of documenting this potential, among our service record, OSR, etc. When placed side by side in order, fitness reports should read like a storyline of your achievements and impact with the overall emphasis on your potential to lead at the next higher-grade level.

Promotion is not a reward for hard work, rather it is a bill of confidence in our ability to lead the Navy at the next level.

Leadership is the main ingredient that the Navy wants in its young officers, but it is absolutely essential in its mid- and senior-grade officers. If you haven’t proven that beyond others in your grade by the time you are in-zone for promotion, then selection will not happen. Working hard is not a PA-centric trait. A lot of people work hard, but what sets some from that group apart? Leaders are not promoted because they are hard working. They are promoted because they have demonstrated an extraordinary level of both character and competence. They are promoted because of their potential to lead at progressively higher levels. So demonstrate that and write it.

Step out of your comfort zone. Demonstrate that you are more than a great PA, that you are more than a just a great provider and teacher, more than just professionally competent and hard-working. All of those are fine and necessary attributes, but they do not break you out. While those attributes demonstrate the value of what we provide, they do not go the step further to prove we have what it takes to lead at higher levels of influence within the Navy. We need to do better with our career planning, better with our career choices, better with our writing, better about getting involved outside our clinics and treatment rooms, and prove to the Navy that PAs can and should be in executive positions of influence.

SUGGESTIONS TO HELP SET YOURSELF ON THE RIGHT TRACK IN YOUR NAVY CAREER

1. EARLY PLANNING/CAREER ROADMAPPING
2. WELL WRITTEN FITNESS REPORTS
3. CONSISTENT RECORD MANAGEMENT
4. SOLID MENTORSHIP

EARLY PLANNING & CAREER MAPPING

Eisenhower once said plans are worthless, but planning is essential. You may not know exactly where you want to be in 5 or 10 years, but make sure to always stay on a progressive course. Things change, sure, but there should always be an awareness of your big picture. A birds-eye view, so to speak. Your map should be heterogeneous in its mix of duties, positions, PCS moves, while maintaining a consistent trajectory of increasing responsibilities and challenges. Do not be passive with your career.

1. Where are you on the lineal list? You should have an idea of when you will be up for board. The lineal list is published every year in the fall. You should also know how your billet selections and thus FITREPs will line up respective to the board. Generally you have 2 looks below zone before a look in-zone. The number of years can vary, but you should have at least 2 different tours between boards.
2. Given our jobs, we are notorious for 1 of 1 FITREPs. That is fine, but in your planning, try to have at least one opportunity to be rated against your peers. It substantiates your high marked 1 of 1 reports, and a promotion board will notice this.
3. Resources for helping you plan and map include mentors, other PA and MSC colleagues, CDBs, and online resources. I have listed some of these resources below.

CAPTURING WHAT YOU DO

1. Fitness reports articulate what leadership, challenges, and impact you have had along the way. They should be concise, inclusive, and well-written. They should tell your story to the board.
2. Be wary of the “common” accomplishments. Stand out. Be leader focused and less clinical focused.

How does this sound for block 41 of LT ANYBODY:

Although that may sound good, and generally is good, understand other MSCs are doing more and writing better. So should you.

RECIPE FOR A BETTER FITNESS REPORT

Bottom line objectives for any officer fitness report:

1. Does the report illustrate the officer’s leadership, mission effectiveness, and impact?
2. Does the report clearly demonstrate the officer’s character and competence for the next grade?

Fitness reports should be timely, realistic, and accurate. They are also our own responsibility as officers. How they are written reflects less on our chain of command and more on our own selves. A typo or grammatical error may not be the end of the world. However, some may look at that as carelessness and inattention to detail - not great traits the Navy wants in its leaders who are responsible for others’ administrative requirements. I encourage you to reference BUPERSINST 1610.10E, Navy Performance Manual, when writing any evaluation or fitness report.

Let’s look at some specific areas of the fitness report (FITREP):

BLOCK 29

Try to get a different title in the box other than PHYSICIAN ASST. I am not saying it is bad to be a PA, but a board already knows that you are a PA. They assume you are already doing a great job in that field. Try to break yourself apart. Especially if it is a “milestone title.” If you put DIVO or DEPT HEAD or OIC in the box, then you can always add a second primary as physician assistant, while emphasizing that you are directly leading people. Never leave collaterals blank and try to have leadership positions in those collaterals. If you are 1 of 1 at a non-Navy billet, make sure that you follow 1610.10E to the letter. Your rater may not be facile with the peculiar requirements of Navy FITREPs, and a promotion board will not care.

BLOCKS 33-39

There is no great direction on these. This is up to your chain of command and high marks need to be substantiated in block 41. If you are at a 1 of 1 command, be careful not to overinflate these marks. In my 28-year career, I have never filled in my own marks. Let your words speak for themselves. If there were a single trait for which I would strive for the highest mark, it would be 38 - Leadership. These blocks do not necessarily make the FITREP, in my opinion. A 3.0 is great. A 4.0 is better. A 5.0 is the best. If you think you warrant a higher mark, qualify it in block 41. Ideally, your target average for these traits (Individual Trait Average or ITA) should be at or above the summary group average and the rater’s summary average. If it is not on your first report, then make sure it is on the next, and continues to progress that direction.

BLOCK 40

It matters! Do not blow it off or leave it blank, but make sure your choices are realistic and appropriate, and they should only reflect assignments that you are qualified for. They should also be specific. Consider milestones consistent with your next step. And remember, FITREPs are not only looked at for promotion, but also career positions, assignments, advanced training, DUINS programs, etc.

BLOCK 41

It really matters!

1. Follow your local CO guidance always, but some general rules that have guided my writing:
   1. 3-5 bullets from most important/impactful to least and must justify the marks given.
   2. Bullets should generally show cause and effect. State 1. What action you did, 2. The effect or result it had, and 3. The impact it had. Bullets should not just state what you did or just show a job description. Emphasize the results and impact of those actions/positions and use metrics. What did you do to improve this from what it was?
   3. Metrics always trump generalities. “…taught 16 heat injury prevention classes that led to a significant reduction in heat casualties…” would read better as, “…taught heat injury prevention to 475 personnel over a 9 month period directly contributing to a 45 percent reduction in heat casualties this cycle and the lowest rate in 6 years. Actions recognized with the 2016 CG Blue Cross award.”
   4. Your audience should be the promotion board. Write your FITREP to them. Ensure you answer the “so what?” questions. You’re the battalion surgeon. So what? You evaluated 1400 patients this cycle. So what? Here are a few examples with possible edits:
      1. “Implemented a circuit rider team consisting of surgeons, nurses and technicians to conduct a monthly on-site orthopedic clinic.” So what? “…saving 5 local commands 350K in TAD funds and 625 lost man days per year.”
      2. “Organized command wide family practice symposium.” So what? “…Actions improved provider competency and strengthened network capabilities across the fleet while rewarding 530 CME at zero cost to the Navy.”
      3. “Mentored 33 enlisted and junior officers in professional and personal development.” So what? “…Hosted 3 forums and 1-on-1 mentorship for 33 enlisted, residents, and junior officers culminating in 11 interviews and 3 recommendation letters which resulted in 7 selections to various programs and a positive impact on retention and recruitment initiatives.”
   5. Remember that the opening and closing statements are written directly to and for the board. Having a soft rank opening statement on a CVN fitness report, for example, can be extraordinarily impactive: “#5 of 55 Lieutenants across all designators” speaks volumes to a promotion board, especially as a staff officer among a carrier made up mostly of line officers.
   6. Tame the fluff! Avoid fluffiness or flowery language without substance. Make sure your words are supported by facts. Let the facts speak for themselves.
   7. General opinion on the recommended amount of white space varies, so I would suggest sticking with local guidance. BLUF: It should be easy to read with perfect grammar and spelling, and the header/footer should stand out on their own.
   8. Cut and paste what you have into Word and spellcheck it. 18 lines total with space between the header and footer are good rules to follow. Consider using a template: https://www.public.navy.mil/bupers-npc/career/performanceevaluation/Documents/NAVFIT98A%20BLK41-43%20Template%20.docx
2. Bullet topic suggestions:
   1. Promotion board priorities change, but some things remain constant - like leadership. Make sure your FITREP reads “LEADER” and not just how many patients you see. What and whom are you directly leading? Sure we lead as Navy Officers, but go beyond that? Having that title of “Division Officer” or “Department Head” comes with it a universal understanding of the challenges and level of risk a Naval Officer is faced with in these positions. Include the manpower size and budget accountable in block 29. “Chairman” or “Vice Chairman” comes with a universal knowledge of group collaboration, teamwork, and achieving results. These opportunities are out there - ask! And they make you better. Leading a symposium or teaching a professional course demonstrates your ability to communicate effectively and speak comfortably to large groups, all essential and demonstrative traits for what is expected of mid to senior grade officers.
   2. What are your contributions to READINESS? Improving readiness grabs the attention of high level leadership and thus a promotion board. Find a baseline of your unit’s patients on LIMDU - how quickly can you turn them around back to full duty? Quantify that. What process improvement initiatives have you been key to creating or leading that ensured Marines and Sailors got back to duty quicker? How have you improved what used to be the standard? Fleet leaders love this.
   3. What is your direct impact to MISSION ACCOMPLISHMENT? Think beyond the fact that you see many patients that contribute. We know that. What else do you do? A good start is to look at your CO’s philosophy, mission, and strategic plan. What are you doing that directly impacts or improves them? Articulate it. What is the SG’s vision, mission, guiding principles and priorities? What are you doing that impacts them? How are you making a difference locally, in your MSC community, big Navy, operationally, etc.? Demonstrate you are the one to invest more in.
   4. What have you done for RECRUITMENT and RETENTION? Did you sit any interview boards or write any letters of recommendation? Did you influence a sailor’s successful selection to something? MENTORSHIP? What are you doing for officer and enlisted professional development/growth? Are you active or leading specific programs?
   5. What have you done to improve your own KSA’s - education, certifications, skills and/or capabilities? Have you started JPME? Looking at your OSR/ODC - Do you only have 1-2 service schools, or have you filled the “white space” and demonstrated that you can see patients, but also balance some time to your own professional development and competency? Most PAs have done ACLS or ATLS, but few have completed JPME, POMI, or AMDOC, etc. Take a look at service schools available for PAs.
3. Other suggestions
   1. Request to be a recorder for a board. Contact your ASL and/or detailer. Having a first row seat at the process is extraordinarily helpful on your own direction moving forward.
   2. Write your own fitness report, always. Then send it to your mentor(s) and expect a lot of edits along the way. Writing it gives you control of your story. It also prepares you for writing evaluations and fitness reports for others. And try not to copy items from report to report. At each command, make them read and progress like chapters in a story.
   3. Write your FITREP as if you are already the next rank. If you are a LT, your FITREP should let the reader feel they are reading the accomplishments and impact that a LCDR would have. Don’t give the board any room to question whether you are ready for LCDR or not.
   4. Know your timeline. Typically FITREP input will be requested about 3-4 months ahead of time. O3 FITREP periods end 31 January, which means input will likely be requested due by mid to late October. Give it to them early, and only after you have already vetted it through the people or mentors you trust. Give them the time to make their own edits. And beware the change of command. This information is normally known well ahead of time. So plan accordingly.
      
      

      January	O3
      February	O2
      March	W5/4/3	E5
      April	O5	E9
      June		E4
      July	O6	E3/2/1
      September	W2/1	E8/7
      October	O4
      November		E6

      
      
      
   5. Your chain of command will make the expected chops and then it is ready for a local ranking board if there are other MSCs in your grouping.
   6. The Navy uses NAVFIT98 program to prepare officer fitness reports and group summary reports. Get to know it and make sure you have it downloaded on your desktop or laptop. It takes some getting used to (and should be called NAVFIT “78” in my opinion), but it’s what we use. Because the Navy uses it, you should use it. I do not recommend .pdf, Word or other back door mediums for your submission report. Use Word for grammar and spell check only.

BLOCK 42

IS OVERRATED (IN MY OPINION).

But it is necessary. However, over-worrying about your promotion recommendation ranking is a rookie mistake. Again, let your record speak for itself. Focus on the stuff you have control over, and this will come on its own.

First report at a command - don’t fret the “P”. And don’t let your ego get in the way of this. We all think we are better than a P. You may be surprised at the impact and accomplishments of your MSC colleagues, PA and otherwise. It’s a marathon, not a sprint. Be concerned more about the meat of the report, like blocks 29, 40 and 41. If the facts speak for themselves, any board will look at your PSR and see, for example, that this is your first report at a command. It’s really all about the trend and the substance. As long as promotion recommendation is moving to the right with each subsequent period, and you are working your way to moving your trait average above the Raters Summary Average (RSA), you’re in good shape. Also understand that an MP with soft ranking #4 of 15 officers may be looked upon better by a promotion board than several EP 1 of 1 reports.

There are a maximum number of must promote (MP) and early promote (EP) in a summary group based on the number of individuals being rated in that group. These maximums can be found on page 1-20/21 of BUPERSINST 1610.10E. For the LT summary group example coming later in this paper, there are a total of 9. This means that there can be a maximum: P = 3 MP = 4, EP = 2.

One last point on this - beware how you are lined up with your next command. It is extremely rare to be at a new command and receive an “MP” or “EP” recommendation. Ideally you want your timeline to sync along with your in-zone promotion board. This means having a birds-eye awareness of how you’re tracking. If you are looking at a PCS move that will line you up to have your first FITREP at a command as your in-zone report, maybe an extension at your current command would be something to consider. It may not be an issue at all if you have had several great FITREPs up to that point. Mentors or a CDB can offer great advice on these situations.

OTHER SUGGESTIONS AND INFORMATION

KEEP UP YOUR RECORDS

Make sure your record is current and complete. Once you put on a new rank, a picture should be completed and put into your record. Check and make sure it is there. Also ensure all your fitness reports, awards, training, etc., are also available in your record. Below is a list of what I verify to ensure complete and current:

• Official Military Personnel File (OMPF)
• Officer Summary Record (OSR) and Officer Data Card (ODC)
• Performance Summary Record (PSR)
• Official Navy Photo
• Navy Department Awards Web Service (NDAWS)

Getting items input or making changes can take time. Make sure you do this well ahead of time. Consider a letter to the board if changes are pending but not reflected on your record.

MENTORSHIP

Mentors are essential. Some important prerequisites for choosing a mentor: Choose someone you trust. Choose someone with experience more than yours. Choose someone that has written and edited many reports, and thus demonstrated superb writing ability and finesse. Choose an MSC, and it doesn’t necessarily have to be a PA. Other corps generally have different milestones and different styles and goals for writing fitness reports. They may be good mentors in other aspects of leadership however. You don’t have to have just one mentor. Consider having a “cheerleader” and a “reality checker”. Confidence boosting is great, but bluntness can be necessary. As good as I think my preliminary FITREP write up is, it always comes back from my mentor bleeding red. In the end, I really appreciate that bluntness and the work.

Be a mentor yourself. Mentor a junior officer or corpsman. Mentor a group of officers and enlisted, or even take a step further and help mentor the MSC community as an assistant specialty leader or NAPA officer, to name a few. Check out becoming an IPAP instructor. For 3 years you would have the opportunity to meet incoming PAs and help shape their first steps into becoming a naval officer. There are many ways of becoming a mentor.

KNOW THY COMPETITION

Not the most appropriate terminology, but it is no less descriptive. Do you know who you will be ranked against? A few years ago I did a tally of all the MSC O4s locally in my summary group and immediately felt nausea and complete humility. What I thought I “deserved” was no longer part of my equation. I was in the company of several well-deserving MSC colleagues, all doing great things and filling important leadership roles. There can be nothing more defeating or motivating than realizing the level of accomplishment and success of your competition. You can do the same if not better. If you are at a command with more than one MSC in your summary group, do yourself a favor and learn who you’re up against.

Nothing can jumpstart your fire better than discovering the level of accomplishments and impact from your competition.

If you have several 1 of 1 FITREPs, then understand that once the Navy-wide FY promotion board convenes, you will be up against some that have been ranked #1 of 15 or #3 of 30, etc. A rated FITREP along the way can substantiate, but If you are unable get a rated FITREP, ensure your write-ups are competitive and comparable with these individuals throughout the MSC community. Also consider asking for a soft ranking if possible: you may be one of one among MSC LT’s, however, #2 of 22 across all designators.

RANKING

What would you do if the group ranking responsibility was on you? Imagine you are one of nine O3 MSCs at an MTF with an upcoming FITREP due and subsequent ranking board. Your previous FITREP was a “P” and you are hoping for an “MP” or “EP” this time, especially as you are coming in-zone for promotion. You think you have worked hard enough to have earned this. Given the total number of MSC LT’s, there can be expected to be 2 EPs and possibly 4 MPs.

Below is the scenario along with notes of items you are aware of:

Assuming all on this list are stellar officers and all are contributing great things toward the mission:

• How would you rank these LT’s if you were a local ranking board member?
• How are you basing this ranking?
  • Based on demonstrated leadership potential and future potential to the Navy?
  • Based on tenure/position on lineal list or deserving for hard work?
  • Based on bias because of Subspecialty or friendship?
• Looking at all LT’s and before reading the actual FITREP, did “LT YOU” set themselves up to warrant an MP or EP ranking?

Again, is block 42 MP/EP an award for hard work, or should it be given for demonstrable leadership and ability to take on higher risk? My guess is that given the above information, LT YOU has not given their leadership a strong argument to fight on his/her behalf during the board. The truth is that most everybody are doing their jobs and doing them well and working hard. What sets you apart? How are “you” doing compared to the optometrist that sees her clinic patients, but also is responsible for a department and all the responsibilities that come with that position? How are “you” doing compared to the other PA who looks to be going beyond their clinical job scope? How are “you” doing compared to the PT who manages a robust patient load, but also impacts other areas of the command and overall mission? My hope is that by understanding this early on in your careers will help put things in perspective and motivate your own direction.

Let’s add some information and see if that changes things. Realizing that stagnation can be an issue and that dropping a promotion recommendation can be considerably damaging, it should be avoided if not earned. Especially if everyone continues to have strong performance overall.

Look at the chart below, now with previous FITREP promotion recommendations added in while at this command:

Do you agree with the results of the ranking board? Here are some of the notes:

1. EP 1: After receiving 2 Promotable recommendations in a row, LT Ryan had stepped up his game the following year and received an MP. After not selecting on his in-zone board, he requested an extension and pushed even harder this past year and took the lead on one of the XO’s priority initiative projects with great results.
2. EP 2: LT Rogers came into the command guns ablaze and jumped on the MID DH position which nobody wanted at the time and has had great results which earned him a strong MP on his first FITREP. He has not let up on his impact and is in zone for board this cycle.
3. MP 1: LT Stevens could also easily warrant an EP, however, was just edged out by the other 2. She also has 1 more year until she is in-zone with trend to an EP next year as she comes into zone. She was given a soft rank “#1 MP, and same trait average as EP” - which should be helpful.
4. MP 2, 3, and 4: LT Jones, LT Smith, and LT Paul are all stepping up to MP level compared to the others. LT Smith is a relatively new O3 and has PCS orders in 5 months. He can expect an EP on his transfer FITREP upcoming. LT Jones and LT Paul are trending well.
5. P: LT Johnson and LT Daniels are both new to the command, however, LT Daniels could arguably deserve an MP, but was edged out by LT Paul whose only weakness is kryptonite! LT Daniels should have planned better, allowing him to have a strong 2-3 year observed period going into board. Instead he PCS’d to a new command as he was coming into zone for promotion. Hopefully his previous record stands on itself.
6. Finally LT You. He is going into a 3^rd year at the command and continues to be the go-to productive provider in clinic. Arguable that anybody works harder. However, outside of that, he has not expanded on other opportunities for professional growth and leadership. If this were a 1 of 1 command, he would probably get an EP 1 of 1 report. But he would also have trouble come promotion board time without demonstrative leadership and risk taking. Plus, nobody on the board really knew who he was, even after 3 years at the command. This was not helpful for him.

PLAN!

Catch these situations early on before it is too late. Maybe if LT YOU knew early on the caliber of his competition, it would have given him the spark he needed. Talk to your mentors and your leadership about your goals. Stay active with and expand your career. Step out of box and stay hungry! Your competition are.

GET OUT AND GET INVOLVED

Make sure you step out of your workspace. It’s not about bake sales and committees, it’s about direct leadership, impact, face time and networking. We can ignore and minimize it, but it is reality. And you want to make sure at least a few folks on your local ranking board know you by name and face. Get out of the clinic and make some rounds, just to check in and say hello and offer your assistance to other directors, etc., and if they ever need anything... It’s setting your reputation as the go-to guy. If you’re at an MTF for example, give your directorate or other board representative help fighting your case when the ranking board convenes. It is difficult fighting an officer’s case when that officer has given very little substance to make the argument compared to others being ranked. Conversely, it is much easier to fight for a good ranking, or the “EP” when they can start briefing your fitness report and the other director’s jump in and brief for them - "Oh I know LT Jones, I love that guy, he helped me with..."

OPPORTUNITIES

When you get to a command, any command, be it operational, hospital/clinic, or otherwise, seek out the opportunities, and do it early. Take charge and don’t be passive. And be willing to step out of the clinic. Seek out the opportunities, and at the very least, show your interest to your leadership. And be prepared to fail. At my current command, I interviewed for 4 positions with higher leadership and impact potential unsuccessfully, however, eventually my persistence paid off with the fifth interview. It all happens for a reason, learn from it and stay hungry.

CAREER DEVELOPMENT BOARDS

CDBs are provided for a reason. You should have at least one each tour, but know that you can request more than one at a given tour. There are several reasons CDBs are beneficial, but most of all, they give you a team of MSC experts (MSC Leaders) who can focus on you, your status, and give perspective and advice to succeed. They offer ideas you may not have considered on your roadmap. They may even be those same individuals who will sit on a local ranking board. Regardless, make sure to participate. Check out the MSC CDB Program on milSuite for additional information.

REGULARLY TWEAK YOUR CAREER MAP

Life changes. Your goal to succeed doesn’t. Look at your career roadmap. Look at your OSR/ODC/PSR. Have you demonstrated a variety of assignments? And if you’re early in your career, have you considered what chapters you want to write in your career storyline? There are many options available to PAs - FMF, CVN, MTF, SPECWAR, overseas, teaching, WHMU, DUINS, milestone billets, etc, etc, etc. Demonstrate you can adapt well as a leader in different forums with different sets of challenges.

Deployment? It is my opinion that deployments will carry even more weight in the future, especially if you are in a position of leadership on deployment. If you are lucky enough to be called, then talk with deploying unit leadership early in the pre-deployment process to express an interest to go beyond being the PA. My last deployment had a Nurse Corps officer as the S3. The learning curve for her was steep, but she performed with aplomb and I have known nobody in that position I would trust more. Now she is back home as an emergency room nurse again. The Navy is awesome. Nowhere else could you have the opportunities we have. But they don’t often come to you on a silver platter. Go after them. Take charge of your direction and be active in finding opportunities.

DUINS

A note on DUINS because it is near and dear to my heart. There are currently four primary opportunities for Navy PA’s: Orthopedic Surgery, Aviation Medicine, Emergency Medicine, and General Surgery. It has been a general universal thought that if you select and complete DUINS, it means you are almost ensured selection for promotion come board time. This is not accurate. Many great PAs spent a lot of hard work creating and improving these DUINS opportunities, but they are a career step, not a finish line. A fellowship opens other opportunities and makes you better at what you do. In orthopedic surgery for example, you spend a year working in multiple orthopedic disciplines learning how to read basic and advanced imaging, expanding your diagnostic differential, extending your skills and capabilities, such as clinical procedures and surgical skills well beyond that of pure academics and reading. My time in DUINS was challenging, but what I received from that training has been worth it ten-fold. But it is also not the reason I promoted successfully. Fellowships were created to enable you to take specific billets with specific needs and broaden the influence of PAs. They were not created to make you promote faster or make more money.

TRAINING & CERTIFICATION MAINTENANCE

With NCCPA and state licensure CME maintenance requirements, and regular PA reading, ACLS, ATLS, on and on and on, our PA professional maintenance plates can seem pretty full. But it’s not hard to maintain these, really. And a small trade-off for the compensation in bonuses we receive for being a Navy PA - they are quite substantial compared to other MSCs. For our Navy and promotion, however, check out the most up to date training catalog. Basic Medical Department Officer Course (BMDOC) is essential for new Navy officers. Advanced Medical Department Officer Course (AMDOC) is an O4 essential. But I would highly recommend it regardless. Train up!

SERVICE RECORD/OSR/ODC

These are not on your FITREP, however, they also have big impact on a promotion board. Fill up the white space on your OSR. There should be very few if any blank spaces under service schools. Education: anything above a MPAS is extra and only helpful. AQD’s: I’ve been told by those that know are less important than we think they are. Okay to have a few, but having more than a couple columns may give the impression that you are AQD farming.

Make sure your service record is complete and do it way ahead of time. Don’t assume that others have made sure your photo or awards have made it into your record.

READING

A quick word on reading. It is essential in my opinion. Reading makes us better thinkers and better writers which equals better leaders. Read daily, read often, read non-fiction and read fiction. And read things other than medicine, we do enough of that already. There are tons of great books out there. The CNO Professional Reading Program and the USMC Commandant’s Reading List are helpful places to start. Ask your friends, your mentors, and your trusted folk what they recommend.

FAMILY

Lastly, and most importantly, a word on family. If I could offer some advice. Make sure your spouse is sitting next to you on all of this. Not just a seat at the table, but your number one voice and advocate. The Navy already comes with an abyss of unknowns and uncertainties. Your spouse is your biggest advocate and cheerleader. When you promote, they will be there. When you get awards and accolades. They will be there. When you have to pick up and move in 2-3 years, they will be there taking on everything with you. And they will also be the ones keeping the canopy grounded back home when you deploy. Through thick and thin, they will be there. Don’t keep them in the dark. When you make a decision with your specialty leader and detailer on your next move, make sure they are sitting there with you. And when you write a FITREP or an award, ask for their input and advice as well.

I encourage any and every Navy PA that is concerned about their competitiveness on the MSC arena - change your perspective, and do it early in your career. Broaden the box, or tear down the walls altogether. PLAN AND TAKE RESPONSIBILITY FOR YOUR CAREER! Sure it may change along the way, but you’ll be better prepared for it. How do your next two command choices fit in your plan? How do they improve your ability to lead in the future? Is the timing right? Is an extension at your current command in your best interest? It all matters. Talk to your ASLs and detailer, talk to your mentors, talk to your fellow MSCs, request a CDB. They can each give perspectives that help you achieve your goals and succeed in this competitive environment

When we signed on to become PAs, throughout school, and beyond, nobody ever told us that our number one job is to crank out patients. Why is this so often the overlying theme on our fitness reports? I will always love being a PA. The one thing I can still count on to bring my blood pressure down is having a patient sitting in my exam room telling me their problems so that I may help resolve them. As PAs we will always have this, no matter how far up the ladder we go. We are PAs, after all. In the Navy, however, we have the unique opportunity to go beyond treating patients. We also get paid pretty darn well doing it. The bonuses we have over our non-PA MSC colleagues are pretty remarkable - a testament and appreciation for the hard work of PAs that came before us. We have opportunities that we did not have before. Enjoy them, but definitely get out there and lead before you get left behind.

Best,
CDR(s) Chad Thoemke, PA-C

Resources & References:

1. MSC CDB Program - milSuite
   https://www.milsuite.mil/book/groups/msc-career-development-board-program
2. NAVFIT 98 guide
   https://www.public.navy.mil/bupers-npc/career/performanceevaluation/Documents/NAVFIT98A%20Version%2030%20user%20guide.pdf
3. FITREP RESOURCES/BUPERSINST 1610.10E
   https://www.public.navy.mil/bupers-npc/career/performanceevaluation/Pages/default.aspx
4. Block 41 template
   https://www.public.navy.mil/bupers-npc/career/performanceevaluation/Documents/NAVFIT98A%20BLK41-43%20Template%20.docx
5. BUPERSINST 1610.10E Navy Performance Evaluation System
6. BUMED MEMO 1000 Navy Medical Service Corps Career Development Board Program, 19 Oct 2018
7. MSC CDB Handbook submitted by Career Development Strategic Goal Team, Sept 2018.
8. How to access your FITREPS, PSR, OSR, ODC, etc.
   https://www.bol.navy.mil/bam/
9. Neal Publications; Effective Phrases for Performance Appraisals, 11^th
10. NMPDC Graduate Programs
    https://www.med.navy.mil/sites/nmpdc/professional-development/SitePages/Medical%20Service%20Corps%20Graduate%20Programs.aspx
11. Helpful MilSuite pages:
    1. Navy Medical Service Corps
    2. Navy Physician Assistant and several other subtitles related to Navy PA’s
    3. Navy Medical Service Corps eMentor
    4. Medical Service Corps CDB
12. Officer Learning Continuum
    https://www.med.navy.mil/sites/nmpdc/aboutus/Pages/Officers.aspx
13. FY-21 Leadership Course Offerings published by MSC Career Planner. Ask your ASL for copy.