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
 youth
 mental illness
• Medication adherence
 polypharmacy/the elderly
 health literacy
• Elimination of disparities, especially in the healthcare
workforce
• Health reform
 access to care
 primary 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 plan
Formulated 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
management
monitor vacancies
identify the best qualified officers
monitor skills shortages
• Need to reflect the responsibilities of the
position, not the individual capabilities
Billets (cont.)
• For officers
clear and specific responsibilities
objectively graded billets
real time vacancy monitoring
career development
• For agencies
real-time identification of officers for
positions
electronic referral of candidates
Billets (cont.)
• Standard component
Essential duties
Education
Training
Experience
• Position specific components
Detail of duties
Geographics
Additional 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
450
393
400
350
300
250
200
179
150
111
100
76
55
50
0
0
5
1
16
31
0
6
0
12
0
25
1
8
1
0
1
1
Physicians by Temporary Grade
472
229
178
0
0
01
02
23
03
04
05
06
14
7
1
07
08
09
Medical Officers
450
CDC
400
350
Number
300
250
IHS
200
150
100
NIH
DHS
FDA
50
HRSA
0
1
Agency
OS
ACF
AHRQ
AOA
ATSDR
BOP
CDC
CIA
CMS
DHS
DOD TMA
DOD
EPA
FDA
HRSA
IHS
INTERIOR
NIH
OS
PSC
SAMHSA
USAMRMC
USDA
Top Five Agencies
400
Number of Officers
350
300
99
250
4
200
150
61
12
198
100
73
3
84
4
1
39
94
CDC
DHS
17
3
26
15
FDA
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
50
44
0
25
56
IHS
10
0
14
4
HRSA
13
NIH
Total O5 - O6 Officers/ Officers with 18+ Years Service
300
250
Number of Officers
242
200
150
140
100
107
103
64
50
76
73
41
6 5
3 1
11 3
AHRQ
ATSDR
BOP
Total O5 O6
6
3
Total 18+
5
1
0
2 2
5
9 2
1 1
20
18 10
17 9
5 2
CDC
CMS
DHS
DoD
DOJ
FDA
IHS
HRSA
NIH
OS
PSC
11
242
2
64
9
1
41
140
18
107
17
5
3
103
2
5
2
1
20
73
10
76
9
2
Total O5 - O6 Officers/ Officers with 25+ Years Service
300
250
Number of Officers
242
200
150
140
100
107
64
50
41
15
17
2 0
5
9 1
1 0
3
18 3
6 1
3 0
11 0
AHRQ
ATSDR
BOP
CDC
CMS
DHS
DoD
DOJ
FDA
IHS
HRSA
Total O5 O6
6
3
11
242
2
64
9
1
41
140
Total 25 +
1
0
0
15
0
5
1
0
3
17
0
10
17 1
5 0
NIH
OS
PSC
18
107
17
5
3
10
1
0
Recruitment
Resources vs. Resourcefulness
•Strategic qualitative and quantitative plan and funding
Centrally fund USUHS students
Centrally fund COSTEP programs
Sponsor residents in training
Expanded central and field recruiters
Every officer a recruiter
Placement 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 recruiter
Spirit of volunteerism
No 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 04). 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 readiness
 6 indifferent/retiring
 6 IT issues
 6 busy
 6 angry
 13 working on it
 5 identified a problem and couldn’t get assistance
 3 injury/illness
 3 can’t figure readiness out
 6 OCONUS