Medical Category Issues

U.S. Public Health Service

Clare Helminiak, M.D., M.P.H.

RADM, USPHS

Chief Medical Officer, USPHS

Surgeon General’s Priorities• Prevent childhood obesity• Tobacco prevention/cessation• Violence prevention

youthmental illness

• Medication adherencepolypharmacy/the elderlyhealth literacy

• Elimination of disparities, especially in the healthcare workforce

• Health reformaccess to careprimary care

The Corps

• Executive Review Group

• Conducting review of Corps structures/functions

• Policy and operations of the Corps separated into OCCO/OCCFM/PSC in 2003

• Multiple funding streams

• Coordination/Accountability issues

The Corps (cont.)• Professionalism, Altruism, Patriotism

• “If the Nation did not have the Corps we would have to invent it.”—Dr. Koop

• “Our conclusion is that the flexibility of the present combination of personnel systems and the difficulties involved in changing it outweigh the advantages of any single system, and that none of the other alternatives can meet the needs of the Service as well as the existing combination of systems do-if these systems are used imaginatively and in concert, so that their potentials are fully realized.”

–Folsom Report 1962

The Corps (cont.)• “Never open legislative language unless you

absolutely need to…”• The Law of Unintended Consequences…..• Interpretation of legislative language/Congressional

intent• “Fix it with regulations”• H.R.3590 - Patient Protection and Affordable Care

Act Removed the numerical size cap Reserve officers on active duty became Regular Corps Authorized a Ready Reserve CAD’s, COSTEPS, EIS, etc.

The Corps (cont.)

• DOD officer confirmations nominations signed by the President subject to confirmation by the Senate Armed Services

Committee largely in batch mode - and on a very regular basis

• USPHS officer confirmations nominations signed by the President subject to confirmation by the Senate Committee on Health,

Education, Labor, and Pensions (HELP) USPHS assimilations approved at most twice a year a streamlined process is needed for USPHS to send

appointments to the Senate HELP Committee in a timely manner

The Corps (cont.)

• Request to OMB for Executive Order• Presidential Delegation of Authority

(permanent) for the Secretary to appoint to the Ready Reserve

• Paperwork goes to the President for signature

• Paperwork goes to the Senate for appointment to the Regular Corp

The Corps (cont.)

• Current Corps Reserve officers on active duty were “deemed” into the Regular Corps

• This served as confirmation by the senate and no further action necessary as the Senate approved the officers by passing the legislation

• Orders are needed

The Corps (cont.)

• An entire set of new regulations needed for Regular Corps and the Ready Reserve

• Need an assimilation process for Ready Reserve to become Regular Corps

• Need regulations to terminate Regular Corps officers; can’t terminate in the probationary period since all officers are Regular Corps

GI Bill Transferability

• Request for draft language for the Secretary to review

• Attention and interest from HHS to move this forward

The Corps (cont.)

• Define the domestic and international mission space vision

• Support the vision with a strategic and financial planFormulated in consultation with, and

with the support of, the Dept./Agencies

DA/OP• OP data can then be accessed and used for

multiple purposes to meet officer, agency, personnel, training, and readiness objectives

• Officer profiles with primary source validated degrees, registrations, certifications, and licensure (beyond commissionable degree)

• DA is the new HR system

• Data files shared between OP and DA to create searchable data bases

DA/OP

• Built-in matching functionality allows identification of right officer at right time for right position

• Strategic workforce analysis• Career management/Officer job searches• Agency recruitment• Individual officer’s OP data will be able to be

matched directly to position requirements and/or preferences in the new billet system

Billets

• Needed for effective and efficient force managementmonitor vacanciesidentify the best qualified officersmonitor skills shortages

• Need to reflect the responsibilities of the position, not the individual capabilities

Billets (cont.)

• For officersclear and specific responsibilitiesobjectively graded billetsreal time vacancy monitoringcareer development

• For agencies real-time identification of officers for

positionselectronic referral of candidates

Billets (cont.)

• Standard componentEssential dutiesEducationTrainingExperience

• Position specific componentsDetail of dutiesGeographicsAdditional qualifications

Billets (cont.)

• Deployment eligibility in the billet not deployment assignment

• Only thing specified is the possible deployment eligibility of an officer encumbering a specific billet; deployment assignments made via OFRD

Billets (cont.)• Imbedded in the sheet is an automatic and

objective system for calculating billet points and grades based upon attribute selections

• Not all attributes drive points/grades.

• If the billet is downgraded there is a 2 year grace period to avoid adverse effects

• CPO’s and PAC’s review billets to confirm compatibility and uniformity

Billets (cont.)

• Quarantine officer• CMO: applied public health, clinical, mental

health, research• Clinician: clinical, mental health• Consultant/advisor: applied public health,

clinical, mental health, research• Epidemiologist: applied public health,

investigator, research• Manager/planner

Billets (cont.)

• Inflated billets will be caught by a review process

• PAC’s to pick up red flag outliers

Physicians by Agency

Physicians by Temporary Grade

0

50

100

150

200

250

300

350

400

450

1

Agency

Num

ber

ACFAHRQAOAATSDRBOPCDCCIACMSDHSDOD TMADODEPAFDAHRSAIHSINTERIORNIHOSPSCSAMHSAUSAMRMCUSDA

Medical Officers

HRSA

DHS

FDA

IHS

CDC

NIH

OS

Top Five Agencies

44 25 1556

4 13

198

3926

84

14

94

4

13

12

0

3

99

417

61

10

73

0

50

100

150

200

250

300

350

400

Num

ber

of O

ffice

rs

O6 18+ 99 4 17 61 10 73

O5 18+ 4 1 3 12 0 3

O6 198 39 26 84 14 94

O5 44 25 15 56 4 13

CDC DHS FDA IHS HRSA NIH

Total O5 - O6 Officers/ Officers with 18+ Years Service

6 3 11

242

2

64

9 1

41

140

18

107

17 55 1 3

103

2 5 2 1 20

73

10

76

9 20

50

100

150

200

250

300

Num

ber o

f Offi

cers

Total O5 O6 6 3 11 242 2 64 9 1 41 140 18 107 17 5

Total 18+ 5 1 3 103 2 5 2 1 20 73 10 76 9 2

AHRQ ATSDR BOP CDC CMS DHS DoD DOJ FDA IHS HRSA NIH OS PSC

Total O5 - O6 Officers/ Officers with 25+ Years Service

6 3 11

242

2

64

9 1

41

140

18

107

17 51 0 015

0 5 1 0 317

310

1 00

50

100

150

200

250

300

Num

ber o

f Offi

cers

Total O5 O6 6 3 11 242 2 64 9 1 41 140 18 107 17 5

Total 25 + 1 0 0 15 0 5 1 0 3 17 3 10 1 0

AHRQ ATSDR BOP CDC CMS DHS DoD DOJ FDA IHS HRSA NIH OS PSC

RecruitmentResources vs. Resourcefulness

•Strategic qualitative and quantitative plan and funding Centrally fund USUHS studentsCentrally fund COSTEP programsSponsor residents in training Expanded central and field recruitersEvery officer a recruiterPlacement of senior officers in academia, S/L/T/T high visibility billets, etc.

•Strategic partnership with Dept./Agency leadership/HR with tailored recruitment goals and job matching/assignment counseling

Recruitment

• Associate Recruiter program• “Corps-centric”• #2 Associate Recruiter leads based on the 10

HHS regions and defined # of associate recruiters 10(?) Selected by DCCR

• 5-7 hours per month• Attend recruitment events in their area• Provide applicant follow-up

Assignments

• CAM teams process application packets for Boards

• Need to collaborate with hiring officials

• Match qualified applicants to vacancies

• Robust assignments system

• eCAD, starting with pharmacy and engineer

Retention

•Coherent and funded framework for officer development/training/career paths

Loss of specials pays during training

•Rotational year in all Depts./Agencies

•Every officer a recruiterSpirit of volunteerismNo staff, no funding

•Placement of senior officers in academia, S/L/T/T high visibility billets, etc.

Physician Pilot• 14 physicians brought into the PHS

• Majority of physicians are coming through the “senior physician” route even if they are prior service, since most are eligible for 0-5; even more likely in the future since all officers will be Regular Corps and this was one of the draws of the interservice transfer route

• Only one officer was brought in as 0-4 through the program 

Physician Pilot

• Offer commissions to a limited number (35 per year) of qualified senior civilian physicians such they are able to enter the Corps at the 0-5 rank (currently medical officers can’t be commissioned for extended active duty at ranks higher than 0-4). This would require the removal of current limitations on calculating creditable Training and Experience.

• Waive the 8 year prior military service cap (up to 15 years) as long as the candidate commits to 10 years of active-duty service in the Corps(automatic for qualified candidates rather than through the submission of individual waiver requests)

• Candidates with more than 15 years of prior military service will be considered after the receipt of an appropriate waiver request.

Physician Pilot• targeted blanket waivers of the 44-year age limitation for

accession of medical officers (currently, waivers to the 44-year age limitation are granted only on a case by case basis)

• allow the accession of medical officers on unlimited tours of active duty, and on 3-year limited tours of active duty

• Unlimited Tours of Active Duty-a blanket waiver of the 44-year age limitation for physicians who are Board certified

• 3-Year Limited Tour of Active Duty: for officers who do not quality for the blanket waiver described in institute a blanket age waiver of the 44-year age limitation for physicians who are Board certified or Board eligible

Physician Pilot• family medicine, internal medicine, pediatrics, geriatrics,

obstetrics/gynecology, general surgery, psychiatry, child psychiatry, preventive medicine and infectious disease (adult or pediatric)

• automatic for physicians who are Board certified in the above specialties whose ages are greater than 44 but less than 51 years, rather than through the submission of the individual waiver requests

• regardless of specialty, candidates aged 51 or greater will be considered for accession to unlimited tours of active duty after the receipt of appropriate waiver requests

Readiness

• 54 physician responses to email regarding their lack of readiness6 indifferent/retiring6 IT issues6 busy6 angry13 working on it5 identified a problem and couldn’t get assistance3 injury/illness3 can’t figure readiness out6 OCONUS