Navy Incentive Pay Increases

Started by militaryPHYS
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militaryPHYS said:
What are everybody’s thoughts on the first “real” pay bump for incentive pays since 2017?

Only closed the gap a small percent, but significant in the fact that we are finally seeing increases.
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For primary care and non-proceduralists, I think it's great (I took the bait, I'll be in Shaw Shank for a while). With these bonuses, and with the right BAH, we're making $100-$150/year more than our civilian counterparts. With the dearth of patients in our MHS hospitals and clinic, the job isn't so hard, and won't be hard for the foreseeable future.

Unless of course we go to war with China . . . I guess that's what we're really being paid for, to be on standby should all hell break loose.
 
Depends on the specialty. Some didn’t go up (family, Peds, internal medicine). Some went up less (dermatology by 5k) and some increased more (pathology by 11k or “sub specialty category 1” ie some fellowship trained surgeons by 13k I think was the biggest delta)
 
I think, based off the retention pitches I keep hearing, and all the higher ups supposedly very interested in "how can we keep you" if you're thinking about getting out, along with this, that they're seeing physicians leaving faster than they think they can be replaced. I know in EM, a lot of folks are getting out as soon as their 4 years are up.
 
Yeah there are a lot of specialties that have the same problem. (Vast majority not staying beyond their commitment) This problem is compounded for some by the decisions that were made years ago to cut training spots. Unfortunately as well as communities become undermanned it makes the DoD worse to work for. Worse for detailing, worse for scope of practice, worse for workload, worse for training opportunities. I’m glad to see them making some incremental changes to the pay problem but honestly I don’t think it’s enough to move the needle. They need more drastic changes that help the underlying architecture of the DoD as an employer.
 
Part of the retention issue is that civilian salaries for many specialties have dramatically increased since COVID.

There's always been a substantial pay gap between civilian and military physician pay (obviously some specialties moreso than others), but the gap has really started to stretch the last few years. The job I took the day I left the Navy in June 2022, now pays about 30-40% more than it did the day I left. Anesthesia is one of the more extreme examples, but I see others demanding (and getting) more also.

Add in the cumulative effects of post-COVID inflation, and military physicians were really getting screwed by stagnant pay.

Very glad to see the military has started to make some progress there. It wouldn't surprise me if it's not enough to significantly improve retention though.
 
flightdoc09 said:
I think, based off the retention pitches I keep hearing, and all the higher ups supposedly very interested in "how can we keep you" if you're thinking about getting out, along with this, that they're seeing physicians leaving faster than they think they can be replaced. I know in EM, a lot of folks are getting out as soon as their 4 years are up.
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EM has always been a little weird in the military.

There has always been a lot of interest from med students. The kind of people who join the military are sort of tilted toward the stereotypical ER adventure seeking adrenaline junkie types. I think the EM interest group was by far the largest when I was at USUHS.

I think a lot of them dream of combat trauma, gunshot wounds and blast injuries and traumatic amputations and tough airways and chest tubes and emergency thoractotomies and amazing saves ... and a Role 2 or Role 3 center in a combat zone as the ultimate ER. (And that really is an amazing practice setting ... for the 0-3% of a career one could expect to do that.)

Then reality sets in and the actual military EM practice turns out to be astonishingly low acuity sick call plagued with bull**** URIs and malingerers who don't want to go to work. It's only been recently that more than a handful of military ERs anywhere started allowing civilian trauma through the gate at all.

Low pay, lame work, all the hassles of military bureaucracy, deployments ... the pipeline stays full of starry eyed youngsters who dream of combat emergency medicine, but in the end it's no surprise at all to me that EM leads the charge for the exit door.
 
pgg said:
EM has always been a little weird in the military.
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The specialty as a whole (military or civilian) has become a mess. Most ERs are not Level 1s, are glorified urgent cares, festered with drug seekers and patients who refuse to use their primary care networks for chronic issues. With hospitals accepting all for care, refusing to turn anyone away (even for clear, non-emergencies), demands on decreasing LOS and increasing patient satisfaction (no matter how stupid the request) . . . Emergency Medicine has become anything but Medicine.

The specialty will surely be replaced by an army of NPs with chatbots-iPads.

pgg said:
I think a lot of them dream of combat trauma, gunshot wounds and blast injuries and traumatic amputations and tough airways and chest tubes and emergency thoractotomies
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Yeah, all of which is better seen in the civilian world.
 
flightdoc09 said:
I think, based off the retention pitches I keep hearing, and all the higher ups supposedly very interested in "how can we keep you" if you're thinking about getting out, along with this, that they're seeing physicians leaving faster than they think they can be replaced. I know in EM, a lot of folks are getting out as soon as their 4 years are up.
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It seems like most of the Navy's attempts at retaining EM is a losing battle with our previously stable retention rates dropping to all time lows. Though to be fair, I am not sure what they can do in the current environment to entice those in the EM community to stay beyond their service obligation; unless another conflict breaks out.

We remain "manned" near 100%, but with a disproportionate amount of EM holding leadership billets or other non-EM billets we have been effectively understaffed for years and now with plummeting O4 retention rate the strain is increasing. We are now struggling to minimally staff our MTFs on top of our Marine Corps obligations. Their have been talks of downgrading CONUS/OCONUS EDs to non-EM staffed urgent cares however, unsurprisingly this results in immediate uproar from the line community. On top of this, OP tempo seems to be slowly creeping upwards despite "peace time" with no ship/shore balance. Every other Navy community, SWOs/Pilots/Nukes, seem to recognize that constantly shuffling staff between deployable billets is not sustainable. And yet, Navy medicine seems to increasingly feel the need to be operationally relevant with increasing ERSS and other blue side platforms, plus our long standing green side operational obligations. Now almost every EM billet is "operational" with people getting deployed from even minimally staffed OCONUS MTFs or key leadership/GME positions. Additionally, the constant burden of these taskers further strains those left holding down the fort; no one at my MTF has worked less than 1.3 FTE in the past 2 years. The Navy reserves seem to be experiencing a similar push towards EXMED platforms so getting AD positions back filled by reservist on ADT is next to impossible. Combine this with difficulty maintaining KSAs and increasingly busy MTF (urgent cares) EDs, with short staffing in other primary care communities pushing more people to the EDs. Sure, some of the MTFs are increasing trauma capability which helps KSAs, but this is a small portion of our skill set. Perhaps they could start allowing sick civilian cases at the MTFs like Guam, but most of them can barely handle their current workload due to bare bones staffing, and I'm sure this would be a bureaucratic nightmare.

As with most specialties, I don't think they could realistically bridge the gap with money. They did increase the specialty pay, retention bonuses, and are decreasing the time to O4 (and I suspect decreasing time to O5/O6 will soon follow). However, given most can match their Navy pay working half-time as a civilian, with little-to-no admin requirements ,I think the pay gap is unsurmountable. It seems the current plan is keep pumping up the number of NADDS EM Grads who almost never stay beyond their obligation.
 
I think it’s a bit of a too little too late. For my field, the bonus is better for a 6 year contract, but who would want to sign up for 6 more years?
 
Kais3r_Sos3 said:
Their have been talks of downgrading CONUS/OCONUS EDs to non-EM staffed urgent cares
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There's been talks?! What are they now? If I was an active duty EM, the last place I'd wanna be is in a MTF ER (except for maybe BAMC). I'd rather be operational and moonlight on the side (which most do, very liberally, so they're pulling in 2 paychecks . . . don't shed them a tear).
 
narcusprince said:
i get pay is an issue but what about adequate time off? 30 days of leave is the bare bare minimum I have seen advertised in anesthesia . With most jobs offering 11-26 weeks of vacation.
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Historically part of the military "deal" was that the work was light and you had lots of free time, all the time.

"Half a day's work for half a day's pay"

Except for the deployments, it was a lifestyle job. At least, it was pre-covid. Obviously I don't know how things are now.

I'd take a week of leave and go grind out 70 or 80 hours moonlighting, then come back to the Navy job to recover. Even if the hours approached "full time" the actual minutes were pretty easy and relaxing. (You remember the staffing model ...)


Also I'm not so sure most anesthesia jobs are offering 11-26 weeks now. We get a really skewed view of the market on the anesthesia forum. I think 12 (or less) is still the standard. Naturally the 100% locums guys can take however much vacation they want.
 
pgg said:
Historically part of the military "deal" was that the work was light and you had lots of free time, all the time.

"Half a day's work for half a day's pay"

Except for the deployments, it was a lifestyle job. At least, it was pre-covid. Obviously I don't know how things are now.

I'd take a week of leave and go grind out 70 or 80 hours moonlighting, then come back to the Navy job to recover. Even if the hours approached "full time" the actual minutes were pretty easy and relaxing. (You remember the staffing model ...)


Also I'm not so sure most anesthesia jobs are offering 11-26 weeks now. We get a really skewed view of the market on the anesthesia forum. I think 12 (or less) is still the standard. Naturally the 100% locums guys can take however much vacation they want.
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This is absolutely still true, and not just for anes . . . true for most specialties. I'd even regard it as waste fraud and abuse that the military employs certain specialties (example, Vascular Surgery) and hardly utilizes them.
 
DrMetal said:
This is absolutely still true, and not just for anes . . . true for most specialties. I'd even regard it as waste fraud and abuse that the military employs certain specialties (example, Vascular Surgery) and hardly utilizes them.
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Yeah, I always found it interesting when specialized surgeons would see patients at the MTF, and then schedule their surgery at a place they would moonlight out in town. I don't blame them for wanting nurses and techs that are more familiar with those procedures watching over the patient as they recover, but it still seems pretty shady. I don't know how their pay worked for such procedures either.
 
flightdoc09 said:
Yeah, I always found it interesting when specialized surgeons would see patients at the MTF, and then schedule their surgery at a place they would moonlight out in town. I don't blame them for wanting nurses and techs that are more familiar with those procedures watching over the patient as they recover, but it still seems pretty shady. I don't know how their pay worked for such procedures either.
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Oh it gets better than that. They're all Sunlighting.

(Sunlighting is when you moonlight, but during the day, during normal business hours, when you should be at Navy). As long you're at Navy long enough to attend stupid meetings, answer some email, and pee in a cup . . . you're off the radar.

It's our own fault, we allow it. We don't employ people correctly, and there's not enough work to go around. This is why most of the MC should be 'reservized'.
 
flightdoc09 said:
Yeah, I always found it interesting when specialized surgeons would see patients at the MTF, and then schedule their surgery at a place they would moonlight out in town. I don't blame them for wanting nurses and techs that are more familiar with those procedures watching over the patient as they recover, but it still seems pretty shady. I don't know how their pay worked for such procedures either.
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If they are charging for it that’s against the rules for moonlighting. You aren’t allowed to charge for tricare patients and you certainly aren’t allowed to refer patients to yourself. People do sometimes have MOUs that let them work at civilian centers for free.
 
DrMetal said:
Oh it gets better than that. They're all Sunlighting.

(Sunlighting is when you moonlight, but during the day, during normal business hours, when you should be at Navy). As long you're at Navy long enough to attend stupid meetings, answer some email, and pee in a cup . . . you're off the radar.

It's our own fault, we allow it. We don't employ people correctly, and there's not enough work to go around. This is why most of the MC should be 'reservized'.
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Moonlighting should be between the command and the individual member. When off duty IE post call or not officially on duty or on leave you should be able to moonlight. Unfortunately commands have many different interpretations of the rules and enforcement comes down to who the command chooses to hold accountable.
I remember their was a doctor who was climbing a mountain and got in a horrific accident on a mountain overseas while on leave. I was certain this leave was not approved for that activity and overseas. He got a slap on the wrist while others were held accountable for lesser offenses.
Dualisms of justice in the military was a big reason I left. I also witnessed an orthopedic surgeon get his teeth cleaned while his patient was on the table. The patient had complications. The surgeon was not held accountable because he was a good old boy.
 
DrMetal said:
For primary care and non-proceduralists, I think it's great (I took the bait, I'll be in Shaw Shank for a while). With these bonuses, and with the right BAH, we're making $100-$150/year more than our civilian counterparts. With the dearth of patients in our MHS hospitals and clinic, the job isn't so hard, and won't be hard for the foreseeable future.

Unless of course we go to war with China . . . I guess that's what we're really being paid for, to be on standby should all hell break loose.
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What’s the total compensation? Outpatient PCP is in the 300s
 
Solutions for all of the above will be coming from DHA. It is obvious that when decisions are left to local command triad, few are willing to be the bad guy to shut down gray area practices mentioned here over fear of peer blowback, IG complaints, etc. Even if rules/boundaries do get set, the next CO may change it. Universal policy will be coming after the closest alligators to the boat are finally dealt with.

Right now, if a specialty can show through case logs, KSA’s, DHMRSi, PDT/VMT or other that they are under-utilized, easy sell for MoU creation with local civ center. Most large medcens have these already for lowest utilized specialties but not necessarily a centralized or coordinated process. Lots of onsie twosies.
 
militaryPHYS said:
Solutions for all of the above will be coming from DHA. It is obvious that when decisions are left to local command triad, few are willing to be the bad guy to shut down gray area practices mentioned here over fear of peer blowback, IG complaints, etc. Even if rules/boundaries do get set, the next CO may change it. Universal policy will be coming after the closest alligators to the boat are finally dealt with.

Right now, if a specialty can show through case logs, KSA’s, DHMRSi, PDT/VMT or other that they are under-utilized, easy sell for MoU creation with local civ center. Most large medcens have these already for lowest utilized specialties but not necessarily a centralized or coordinated process. Lots of onsie twosies.
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Or you could just moonlight . . . today.
 
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