The possible reality of O-5 as terminal rank aside, I don't think I could be a full time clinician and do distance ILE. Some knock it out during deployment, which would be ideal. You would need to set aside one full day per week to work on ILE, based on my review of the amount of work. I guess you could use a weekend day, my wife would kill me. Those just above me in years are doing the 4 month ILE course, rather than trying to do the distance learning. I think the 4 month course is the less painful and more realistic option for me. One painful detail is that if you have been an O-5 for 5 years, you don't qualify for the 4 month course (its in the regulations), and you will likely get passed over a few times for the ILE in residence course. In other words, you have a window to get into ILE residence course and you don't want to turn it down when picked up. If you are in to 20 years like me, it is worth the risk to spend 4 months in ILE. I am 'only a clinician' and plan to stay in that role no matter what, but you never know what may happen. I may involuntarily get sent to do some things that would ultimately qualify me to make O-6 (Brigade Surgeon slot etc). I think you have to keep that possibility in mind if you have a long commitment.