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Newsmaker Profile: Navy Rear Adm. Michael H. Mittelman

Navy Rear Adm. Michael H. Mittelman recently earned his second star, becoming only the second member of the Medical Service Corps to achieve the rank.  Before moving on to his next assignment, he sat down to talk about his time at USJFCOM.

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By Jacob Boyer
USJFCOM Public Affairs

(NORFOLK, Va. - Aug. 18, 2010) -- Navy Rear Adm. Michael H. Mittelman was recently promoted to his second star after serving for nearly two years as both U.S. Joint Forces Command’s (USJFCOM) command surgeon and Allied Command Transformation’s (ACT) medical advisor.  Mittelman, an optometrist, is only the second member of the Medical Service Corps to achieve the rank and is the first optometrist.  He will be moving on to U.S. Pacific Command at the end of August, and he sat down recently to talk about his promotion, his time here, and the challenges both he and his successor will face.

Interviewer:  Why is your promotion is somewhat historic?

Mittelman:  Our first active duty two-star admiral was Rear Adm. Todd Fisher, one of my mentors.  He is an extraordinary man.  To me, he is the model for how Navy medical flag officers should act.  He’s taught me a lot.  I am different in the sense that I am not a health care administrator by training.  Adm. Fisher was, and actually all the previous active duty flag officers in the Medical Service Corps were healthcare administrators.  I am the first clinician Medical Service Corps officer to reach flag rank. 

It’s very unusual for Medical Service Corps officers to go from one star to two because it’s difficult to place us.  We’re competing against physicians, nurses and others in many instances.  In my case, I think because I am a little more flexible – as a clinician, I can be plugged into a myriad of jobs – and it made me a little bit more competitive.  As the deputy commander said in a meeting, maybe they just promoted me out of curiosity.  They wanted to see what would happen.

I was absolutely shocked, honored and flattered to get selected.  It’s neat, because as a two-star, I have the opportunity to serve our great nation and remain in uniform longer.  I get to serve Navy medicine longer and I get to serve the Medical Service Corps longer.

Interviewer:  How does being a clinician help you both in this job and in your future endeavors?

Mittelman:  Historically, the command surgeon jobs at combatant commands have been given to physicians.  I’m an optometrist by training, so I’m a clinician who sees patients and understands all the medical stuff;  I’m just not a physician.  Being a Medical Service Corps clinician allows me to be plugged into these kinds of jobs.  That gives me many opportunities I never would have had if I was not a clinician.  Frankly, it lets me bring a different perspective to these jobs, because I’m an optometrist.  I’m trained a little bit more analytically, so I tend to take a little bit more of an analytical approach to problem solving and addressing other issues that confront me. 

I also have a public health background, which is absolutely perfect for these combatant command jobs, because we do health engagement, we do medical policy and – especially here at USJFCOM – we train others to be good providers in joint task forces.  That’s my background.  That really works out very well.  The Navy surgeon general can pretty much put me anywhere in the enterprise.  I think that helps me and it also helps him. 

Interviewer:  What sets optometrists and physicians apart?

Mittelman:  A physician goes to medical school.  They go through internships and residencies before going off to do their things.  Optometrists go through four years of optometry school after college and a lot of us go on to residency programs.  I didn’t because of when I trained, but I went and got a master’s degree in public health and off I went.  As an optometrist, I don’t do surgery.  I do medical treatment of ocular disease.  I diagnose and treat refractive anomalies; glasses and things along those lines.  I’m a pretty broad brush, but I don’t do surgery.  That’s the defining line.

There’s a lot of confusion even between optometry and ophthalmology because the line between the two professions has blended over the years.  Thirty-five years ago, optometry was a drugless profession.  Optometrists dispensed glasses and contact lenses.  Now, the profession has evolved into the primary eyecare profession where we’re treating glaucoma and other diseases of the eye the same way an ophthalmologist would.

Interviewer:  What are some of the unique challenges you and your staff have faced while you’ve been here at USJFCOM?

Mittelman:  A lot of it comes from the fact that U.S. Joint Forces Command is so diverse.  Our mission set here is huge.  The force provider and trainer jobs here are what I see as my primary roles. 

My challenge with the force provider role was leveling the playing field, ensuring that all of the services’ equities were appropriately managed and represented so that when we had a requirement from a COCOM, all the services got an equal look.  That was my first challenge when I got here: getting everybody to the table, getting them to understand that we are the honest broker for force provision, and ensuring them that we were going to play fairly with all of them.  That took about six months to get right.  We just had to get people to the table and get them to communicate openly.  I see that as a real success, because we’ve met 100 percent of the requirements.  A lot of the credit goes to my planning staff, but I think a lot of it is because of the trust that we’ve built with the components.

The other piece is the training.  We have taken training to a new plane.  We’ve made the Senior Medical Leader Seminar much more relevant and timely.  We have done just in time training for embedded training teams that have been going into theater.  We saw the requirement and got in there and fixed what was broken.  Now we’re training people before they go forward so they understand what the mission is and they understand the culture.  We’re doing expectation management for providers going forward, so they understand that when they go into a hospital in Kabul, they may not have an MRI with electricity.  They may have other things.  They’re certainly not going to see what we have here in our medical centers.  We have put that together.  I’m very proud of that.

One of our capstone documents is the Force Health Protection Concept of Operations.  That is something we have codified along with the Joint Staff. What we’ve been able to do is institutionalize medical requirements from today to five to 10 years from now.  That is now written in doctrine.  That has not been done before.  What that does for us is it’s shown us the gaps we need to fill with equipment, training and various skill sets.  That paints a roadmap for what the funding picture will be for medical requirements into the future.  When one of the services says “We need X,” we can show why they need X.  When the bean counters look at that, they’ll be able to see there really is a requirement.  I’m extremely proud of that.

Interviewer:  As far as force provision for units in theaters of operations, you’re probably the person who has the best view.

Mittelman:  I’ve got the most global view of the shortfalls.  What we struggle with isn’t basic hospital corpsmen or medics.  Thank goodness each of the services has an appropriate inventory of those.  They’re our most important providers in my opinion.  They’re our first line of defense.  They’re the people who are saving lives out there, undoubtedly.

Where we run into challenges are the high-demand, low-density specialties: mental health providers.  Read any paper.  It’s on the front page.  They talk about traumatic brain injuries.  We’re going to be faced with dealing with these mild to severe traumatic brain injury patients for a generation.  That requires a cadre of mental health providers, everything from social workers to very skilled psychiatrists.  In the middle, you’ve got technicians and all these other folks who need to assist them.  We don’t have an inventory to support that.  None of the services do. 

One of my jobs is to work with the services to make sure we’re meeting the requirements in theater and that’s always a juggling act.  What the Army doesn’t have, maybe the Navy or the Air Force does, but now we’re almost out across the board.  Mental health is a challenge and we’re always working with that to make sure that we’re meeting the requirements.

The other challenges we have are critical care nursing; making sure we get the patients from point A to point B safely.  The surgical specialties are always in high demand: anesthesiologists, emergency physicians, general surgeons and orthopedic surgeons.  I ultimately have to step in and negotiate with the components’ surgeons to make sure that everybody’s at the table, I have visibility of all their assets, and we’re able to come up with a sourcing solution.  Our process here is very fair.  The end result always has to be that the COCOM gets what it needs.  People are oftentimes forced to source certain solutions, so oftentimes I have to explain why. 

Here at JFCOM, we don’t make the choice; we make the recommendation.  The recommendation goes to the Joint Staff and they present our recommendations to the secretary of Defense and he will play Solomon if necessary.  I’m amazed and proud to tell you that he hasn’t changed any of our recommendations while I’ve been here.  That tells you that our guys who have been doing the staff work are doing a very good job. 

It also tells you the components have stepped up to the plate pretty much every time they’ve needed to and that tells me we’re working together as a team.  A lot of times, nobody wants to provide these important medical assets, because when you take a mental health provider out of a medical treatment facility here, then somebody in garrison who’s not getting seen by a uniformed provider.  That changes the picture, because I’d rather our mental health patients be seen by somebody in uniform, not a civilian provider.  That’s the conundrum we’re faced with all the time.

Interviewer:  Getting the Restorative Medicine Working Group running has been a good success story during your time here.

Mittelman: (Marine Corps) Gen. (James N.) Mattis, (former USJFCOM commander) asked me to look into how we could generate support for the regenerative medicine initiatives going on around the country right now at places like the University of Pittsburgh, the Cleveland Clinic, UCLA, Wake Forest, and others.  I’ve been to many of these places and want to go to others.  It’s cutting-edge science.  A lot of it is experimental, so they have clinical trials going on.  We wanted to make sure our wounded warriors have access to these cutting-edge clinical trials. 

In the past, it just wasn’t happening, so I called a summit together here where I brought in the key players from academia, the services, the Department of Veterans Affairs and the TRICARE Management Agency.  We came to consensus at this meeting.  The end result is that TRICARE is working to change its policy to allow for funding of these programs.  They rewrote the policy and it’s in the approval chain now.  Within a couple of months it should be signed off.  We also brought the VA into this. I will continue to watch it carefully and will remain very engaged.

I’m very pleased.  I’ll give you an example.  We had a wounded warrior who had a very complicated ankle issue and was being seen by the VA and it wasn’t working out.  I got on the phone and called our colleagues at the Cleveland Clinic.  Because we’ve worked out these relationships, they’re going to see this guy at no cost to him.  These are world-class experts and they’ll come up with something.  Here at JFCOM, while it’s not our direct role to do this, we took it upon ourselves to be the facilitator.  We don’t have a dog in the fight other than to make sure our wounded warriors get the care they need.  We have a very altruistic motive, which is to take care of those wounded warriors.  I’m not worried about the policy piece.  I’m not worried about stepping on the services’ toes.  I just want to get our wounded warriors taken care of and I come at it like that.  That’s what I think gave us success here.  We weren’t threatening anybody.

I’ve been able to build relationships from here with these institutions and also the services.  That’s been helpful.  [Navy] Adm. Chris Hunter, the director of the TRICARE Management Agency has been absolutely fantastic in picking up the baton and running with it.  It’s been a team effort that has worked out beautifully.  I’m absolutely thrilled.  The proof in the pudding to me was when I called the Cleveland Clinic and said “We haven’t worked this out yet, but can you take care of this Vietnam-era veteran?” and they didn’t hesitate.  The funding piece got taken care of.  If we’ve just taken care of one person, we’ve done a lot and we’ve done a lot more than that already, so it’s working.  Gen. Mattis told me people are coming up to him in different venues and telling him about how our meeting has really helped facilitate the movement of information and people.  That, to me, is a success.

Interviewer:  What are some of the other successes?

Mittelman:  I have none.  The staff has all the successes.  I’m the mouthpiece and the door opener.  The staff, whether it’s my deputy or others here and on my NATO staff, are doing the heavy lifting.  Every once in a while, I come up with a good idea, but they are the ones who are really doing the work.  I can’t brag about them enough because they just make me look good.  They work in the background and that’s the way the military works.  I want to make sure that they get all the credit for all this stuff that gets done because they’re the ones who are doing it.

I talked about the force health protection CONOPS.  We’ve got contractors who work on that funded by the Joint Staff who happen to be down here working with us.  I’ve got [Navy] Capt. Chuck Rhodes.  Before that, I had [Navy] Capt. Diana Novack.  Making sure that all of this work was in alignment with what we do here at USJFCOM was important.  I didn’t want them to write a book report.  I didn’t want a piece of paper to put on a shelf.  I wanted a living document that was no kidding supporting the warfighter, because if it didn’t directly support the warfighter, I didn’t want to hear about it.  They took that to heart.

After Marine Corps Gen. James Cartwright, vice chairman of the Joint Chiefs of Staff, signed it, I had the opportunity to chat with him briefly and he commented that he was very pleased with the way medical had put this together.  It recognized medical command and control for the first time.  That’s not something that’s been recognized before doctrinally.  It’s not magic that we get patients from different places to the right place at the right time for the right treatments.  It’s because we have a very, very well outlined and well exercised command and control doctrine, be it in theater or on garrison.  I’m just thrilled about that.

Interviewer:  I understand you’re moving onto U.S. Pacific Command (USPACOM).

Mittelman:  I am.  Somebody’s got to do it and it’s me.  I was the commanding officer at U.S. Naval Hospital Okinawa, Japan, in what seems like a prior life, so I am one of the few Navy medicine flag officers who has experience in that area of responsibility (AOR). 

Vice Adm. Adam Robinson Jr., the Navy surgeon general, told me that he wanted me to go out there because of my experience and seniority because we have so many things going on in the Pacific right now.  You can read the newspapers about Korea and China.  You can read the newspapers about avian flu.  Vietnam is a wonderful place for us to start working with closely with and medical is the perfect way to open the door for that, so I’ll be doing a lot of medical engagement.  My NATO experience will help me out with that.  It’s a huge job with a huge AOR obviously. 

Interviewer:  Is there anything else you’d like to say?

Mittelman:  In regard to being promoted, first of all, I was surprised.  Second, I was absolutely honored.  It’s funny.  I was talking to my wife about getting excited about the ceremony because we’re getting ready to move and everything.  I was having a hard time getting excited about it.  I’m thrilled, but it hit me the other day how important all this is for Navy medicine and the Medical Service Corps.  I’m putting pressure on myself, but this is unbelievably important for the corps, because it’s the first time we’ve really been able to be operational in a very senior position.

Our flag officers in the past were administrators.  They sat in Washington and they developed and executed healthcare policy.  I’m getting out there and doing it now.  I’m actually able to really affect the way we take care of the warfighter.  That’s an unbelievable honor and privilege, and that is not lost upon me.