Navy Anesthesiology Update 2008 CAPT Ivan Lesnik Navy Anesthesia Specialty Leader

VADM Adam M. Robinson Navy Surgeon General  Strategic Goals  1. Deployment Readiness -Every uniformed member of Navy Medicine will be fully deployable based on successful achievement of all training, administrative, and medical readiness requirements  2. Agile Forces -The Naval Forces will have the right capabilities to deliver consistent, appropriate, and timely health care services across the entire range of joint military operations  3. Effective Force Health Protection - Navy Medicine will promote healthy Naval forces and ensure Warfighters are medically prepared to meet their mission  4. People -Navy Medicine will maintain the right workforce to deliver medical capabilities across the full range of military operations through the appropriate mix of accession, retention, education, and training incentives  5. Quality of Care - Navy Medicine health services outcomes meet or exceed patient quality expectations. Our providers deliver the best and current practice complemented by convenient access, lasting results, preventive health, and mitigation of health risk  6. Patient and Family-Centered Care - Patient and Family-Centered Care is Navy Medicine’s core concept of care. It identifies each patient as a participant in his or her own health care and recognizes the vital importance of the family, military culture, and the chain of command in supporting our patients  7. Performance-Based Budget - Performance-Based Budgeting transforms Navy Medicine from historically based fiscal planning and execution into a process which links resources to performance goals  8. Research and Development - Navy Medicine will conduct relevant research, development, testing, evaluation, and clinical investigations which protect and improve the health of those in our care

Manning  129 Navy active duty anesthesiologists  95 % Manned after 2008 PCS season  FY Authorized billets 10 Fair share billets - Non-clinical Manning % calculated against - AB + FS =138 We have 6 anesthesiologists filling partial to fully non-clinical roles - not in anes billets

Manning 2009 PCS season  -17 losses : 17 RAD  -7 Fellowships: 5 FTOS, 2 FTIS  +41 Gains: 18 GME, 18 NADDS, 5 Fellows  -5 Cont deferral into NADDS fellowship  + 19 FTE billeted anesthesiologist in 2009! May increase fellowship numbers at GMESB

Navy Anesthesia GME  17 FTIS CA-1 positions - (2008 start)  1 FTIS Fellowship - Pain  NMCSD - 2nd Pain Fellowship  LCDR Steve Hanling PD - 1st start 2009  Initial ACGME 2 year accreditation  2008 application cycle (2009 start)  Final numbers not released  16 FTIS CA-1 Starts  No (NADDS) for entire GME pool  4 FTOS / 2 Pre-select -2010/11, 2 RAD - NADDS

Navy Medical Manning & GME  GMO conversions: Over four years phased conversion of PGY-1 level physician billets (GMOs, Flight Surgeons, UMOs) to residency trained primary care providers.  On October 1 st (2007) /553 PGY-1 level billets converted to primary care specialists, including all BSO-18 MTFs GMO billets  100/year - the remaining 447 will be converted over the coming 4 years.  Beginning with the fall 2007 GME selection board, residency starts in primary care specialties will ramp- up.

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

2008 Fellowship Gains 10 Fellows 2 CT- NNMC/NMCSD 3/4 PEDS 5 Pain 2009 Projected Starts 12 Fellows 2 CT 1 PEDS 1 OB 3 Pain 3 Regional 2 Critical Care 2009 Fellowship Gains 5 Fellows 2 Critical Care 1 Pain 2 Peds

Current Operational  50% of anesthesiologists on active duty have deployed since OCT  Few -(3) are considered non-deployable  83% of those separated since 2001 have deployed  6 have deployed more then once - variable lengths  No repeat deployments since success of global sourcing  Approx 9 Anesthesiologists currently deployed in support of all OPS - Military and Humanitarian  (OCT 08 )

Of Note Continued support of UPAC Drawover Death of Narcomed M - Birth of Son of Narcomed Conscious sedation policy standardization Electronic Medical Record - great success in achieving IIP funding for all of DOD from HA- BZ to CAPT Darin Via Continued improvement in special pays

Promotion  O-6 Selection Stats  Of those selected  18/70 above zone = 26%  50/70 in zone = 71%  2/70 below zone = 3%  Of the eligibles  18/161 above zone = 11%  50/86 in zone = 58%  2/174 early select 1%

Future Operational Sea basing of Navy Marine Corps Operations  Shipboard Surgical Systems  Sea Based FRSS element  Cross-deck platform capability  Wide range use asset

Resource Conflict: Away vs Home team  Direct/Indirect effects Program Budget Decision (PBD) 712  Broader application of concept in CONUS MTFs  Military personnel prioritization  Civilianization - Contracted Care  MRR - The Medical Readiness Review (MRR) was (Is) the component of the QDR that reviewed our medical readiness posture and options for our future force structure LBS Gorilla “The Secretary of Defense estimates there are 300,000 jobs performed by military personnel that could be performed by civilians. Converting these military positions to civilian positions may eventually free up money to recapitalize and modernize the fleet”

Resource Conflict: Away vs Home team  Program Budget Decision (PBD) 712 Naval Medicine's share was 1772 positions: 536 Officer 161 Medical Corps, 103 Dental Corps, 187Medical Service Corps 84 Nurse Corp 1236 Enlisted billets Medical Readiness Review - Likely to result in a whole new way of doing business!

Resource Conflict: Away vs Home team  Program Budget Decision (PBD) 712 Naval Medicine's share is 1772 positions: 536 Officer Pediatrics58 Family Practice40 Internal Medicine16 Psychiatry13 Dermatology10 Pathology9 OB/GYN6 Physical Medicine3 Neurology3 Ophthalmology2 Nuclear Medicine2

Electronic Medical Record  NMCSD - PDA based eCPR (pilot complete)  NH Pensacola - AMP funded - DocuSys  NMCP - Drager Innovian Generating standard system requirements necessary for Navy MTF deployments - Shooting for a triserivce adoption

Current Events Addressing JCAHO  Navy Medical and Dental administrative merger  Bringing dental sedation practice under the MTF sedation policy  Interoperative awareness and sentinel event alert (SEA) - OCT 2004

Big “3” Pow-Wow This is our “community” we will jointly determine the course to steer Above board “open shop” collaboration- only one turf to guard - “Navy Anesthesia ”

Big “3” Pow-Wow  Rational for effective collaboration  Winds of change from the front office  Limited resources & focused allocation  One voice - success in getting our way

Big “3” Pow-Wow  Joint Issues  Subspecialty manning

“3” Pow-Wow  Joint Issues  Workload capture and productivity benchmarks  Additional Issues  Pain clinic RVU ’ s  OB workload capture - can we collect tASA units?  Stance on individual profiling of anesthesiologist - as a command fitrep ranking tool  Down the road discussion - what measures for what purpose  How do we factor in CRNAs - transparent vs. full or partial FTE?

Big “3” Pow-Wow  Joint Issues  Academics  Expansion of residency training requirements  Visiting - “ distinguished ” professor series  Navy MTF resident rotation  Multi-center research  Operational platform training

Big “3” Pow-Wow  Joint Issues  Meeting community needs  Billet shuffle 2005  Okinawa 2005  Navy social gathering 2005 New Orleans

Big “3” Pow-Wow  Joint Issues  How do we move forward? Sustaining momentum   Periodic VTC  Annual Meetings

Future Operational Sea basing of Navy Marine Corps Operations “ Arthur also addressed the possibility of decommissioning the Navy's two hospital ships, USNS Comfort and USNS Mercy We're looking at a platform the Navy is already using and making sure we have enough medical capabilities on the ship to be able to use it for dual use," said Arthur. "So when the Marines go ashore, we still have a large medical capability to be able to take casualties back. "I think that's were we'll go in the future. ” Navy and Marine Corps Medical News - Oct. 8, 2004 CNO’s “ Sea Power 21” Sea Basing as a pillar of the 21 st century Navy

Future Manning  Surgeon General's focus on aligning “Human Capital” with mission “We have been asked by the CNO to examine our human capital strategy and how it is aligned to support Navy and Marine Corps missions.” Medical Readiness Review  Total Health Care Support Readiness Requirements ( THCSRR)  181 Navy Anesthesiologists?

Future Manning “The Secretary of Defense estimates there are 300,000 jobs performed by military personnel that could be performed by civilians. Converting these military positions to civilian positions may eventually free up money to recapitalize and modernize the fleet” Surgeon General's focus on aligning “Human Capital” with mission “We have been asked by the CNO to examine our human capital strategy and how it is aligned to support Navy and Marine Corps missions.”

Future Manning  Medical Readiness Review “The Secretary of Defense estimates there are 300,000 jobs performed by military personnel that could be performed by civilians. Converting these military positions to civilian positions may eventually free up money to recapitalize and modernize the fleet”  MRR - The Medical Readiness Review (MRR) was (Is) the component of the QDR that reviewed our medical readiness posture and options for our future force structure

Future Manning  THCSRR The THCSRR model defines readiness requirements as supporting three missions, including (1)A wartime mission meeting the demands of two nearly simultaneous major regional conflicts, including mobilizing hospital ships, supporting Navy fleet and Marine Corps operations ashore and afloat and numerous fleet hospitals, and maintaining military treatment facilities outside the United States; (2) A day-to-day operational support mission for the Navy fleet and Marine Corps that allows Navy personnel to rotate between the United States and operational Navy platforms and overseas assignments and that includes GME (1)A peacetime health benefit mission providing health care benefits in military treatment facilities in the United States. While the Navy views all three missions as imperative to Navy medicine under the THCSRR model, the first two are to determine the number of needed active duty personnel. It is only because of the first two missions of wartime readiness and day-to-day operational support that active duty Navy personnel are to be available to support the third mission of providing peacetime health care benefits. “

Status of Navy Medicine Current Exercises and Operations LEGEND (Personnel Deployed from Home Station) BUMED - RED: 1,647 (-158) MARFOR - GREEN:1,233 (0) FLEET - BLUE: 566 (-7) RESERVE – PURPLE: 290 (0) Total: 3,736 (-165) Total Medical Personnel DEPLOYED INVENTORY RC MTF BKFL AC 3,446 (-165) 31, RC 290 6,937 (-66) 266 (-17) Total 3,736 37, SOUTHCOM 202 PERSONNEL (-20) 189/4/9/0 NORTHCOM 444 PERSONNEL (-31) 33/218/173/20 PACOM 475 PERSONNEL (+40) 202/98/175/0 CENTCOM 2,487 PERSONNEL (-142) 1,212/835/170/270 EUCOM 128 PERSONNEL (-12) 11/78/39/0 As of 19 SEP 06 Total Medical Department Deployed With BSOs 18, 27, 60 & 70 Total Navy Medicine WIA: 347; KIA: 18