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Public Health Service Reorganizes Uniformed Force

Donna Young

The Public Health Service (PHS) Commissioned Corps, the federal government’s nonmilitary, uniformed force of health care professionals, is expanding its force, including adding more pharmacists, and training all of its officers to respond to terrorist attacks, natural disasters, infectious diseases, and other public health needs, said Rear Admiral Arthur J. Lawrence, assistant surgeon general and deputy assistant secretary for health operations for the Department of Health and Human Services (HHS).

The recruitment and training efforts are part of the Bush administration’s plan, announced on July 3 by HHS Secretary Tommy G. Thompson, to restructure the Commissioned Corps, said Lawrence, a pharmacist and 30-year Commissioned Corps veteran.

Commissioned Corps officers are detailed to serve in various government agencies, including FDA, the Indian Health Service (IHS), the Bureau of Prisons, the National Institutes of Health, the Centers for Disease Control and Prevention, and the Department of Homeland Security.

About 50% of the 6000-member force serve with IHS and 20% are detailed to FDA, according to PHS. The restructuring is part of the Bush administration’s initiative to strengthen the public health infrastructure, Lawrence said.

New management. The administration is creating a new organizational entity called the Office of the Commissioned Corps Force Management, which will be supervised by HHS’s assistant secretary for health and will give Surgeon General Richard H. Carmona more formal authority over the day-to-day functions of the Commissioned Corps, Lawrence said.

Before the change, he added, the Surgeon General had to seek clearance from each agency’s department leader before a Commissioned Corps officer could be deployed to respond in times of crisis or assist a community in an operation, such as a mass childhood immunization program.

The Surgeon General will also have expanded authority over Commissioned Corps reserve officers, Lawrence said.

The reserve program has been latent for several years, he noted, but the Surgeon General has been given the task of “revitalizing the reserves to make it more parallel to the military reserves.”

Reserve officers could be activated to supplement regular Commissioned Corps officers in “rolling deployments” during short-term operations to address a community’s public health issues such as immunization or diabetes education programs, Lawrence said.

Reserve officers could also be called to assist during regular missions or when an agency has a shortage of Commissioned Corps officers, he added.

For example, Lawrence explained, IHS has a pharmacist shortage of 12% and most clinics on or near federal Native American reservations have only two pharmacists. If an IHS pharmacist is on leave, a Commissioned Corps reserve pharmacist could fill in during that time.

Recruitment. Captain Robert Pittman, principal pharmacy consultant for IHS, said he hopes to add 60 pharmacists to his staff by this fall, which would drop the pharmacist vacancy rate for the agency to 5%.

PHS Recruitment and Retention Incentives

Captain Robert Pittman, principal pharmacy consultant for the Indian Health Service (IHS), said the Public Health Service (PHS) Commissioned Corps is “pharmacy’s best kept secret.”

Even though pharmacists in community pharmacies are being offered high salaries of $80,000 or more, he said, Commissioned Corps pharmacists have other benefits, such as no taxes on certain portions of their salary and a no-cost health benefit, which make their annual salaries equal in comparison.

The National Defense Authorization Act of 2001 established certain benefits for uniformed officers serving with the military or PHS, including sign-on bonuses and student-loan repayment programs.

Pharmacists who join the Commissioned Corps can receive a bonus of $30,000 for a four-year commitment of service.

The legislation also authorized the military and PHS to offer a special pay of $3,000–$12,000 annually as retention incentives for pharmacy officers. The amount is based on years of service.

Pharmacists who are certified by the Board of Pharmaceutical Specialties are also eligible for a special pay of $2000–$5000 annually based on years of service.

IHS is currently the only agency that provides a loan-repayment program for Commissioned Corps pharmacists, Pittman said.

Pharmacists may receive up to $40,000 for a two-year commitment to IHS and may apply for additional loan-repayments after completing the first two years of service.

PHS also offers a “Costeps” program for students pursuing professional health care degrees, including pharmacy, in which students participate during official school breaks in a paid experiential rotation with a government agency and are commissioned at the rank of ensign.

The program gives pharmacy students in the last two years of a doctor of pharmacy degree program an opportunity to work throughout PHS and gain an understanding of the range of activities public health pharmacists are involved in, said Rear Admiral Richard S. Walling, PHS’s chief pharmacist officer and director of HHS’s office of global health affairs.

A student who completes the program and joins PHS after graduating can count time spent in the Costeps program toward his or her years of service with PHS, he added.

“Even if they don’t come into the Public Health Service, they get engaged in public health, such as immunization programs,” Walling said. “All of the work centered around [emergency] preparedness and bioterrorism response is done with us. The more pharmacists know about public health, the better off they are to help in their communities. All emergencies are local.”

IHS has 202 facilities with pharmacies that serve 1.5 million Native Americans and Alaskan Natives in 35 states, he said. But, he noted, about 1 million Native Americans live outside of areas served by IHS clinics. However, Pittman added, some of those people live in urban areas where other health care services are available to them.

HHS’s Thompson pledged in a July 3 speech at the Reserve Officers Association meeting in Washington, D.C., to add at least 275 new Commissioned Corps officers to support IHS by September 30, 2004.

He also committed to create scholarships to recruit as many as 1000 nurses and 100 physicians per year to work in medically underserved areas.

HHS has set aside $2 million from the current federal budget for recruiting and training officers, Lawrence said. Thompson has requested at least $3 million in the proposed budget for next year, he added. 

Phase out of readiness force. As part of the Commissioned Corps transformation, Lawrence said, PHS will phase out its Commissioned Corps Readiness Force (CCRF), commissioned officers who are specially trained to respond to public health emergencies and disasters.

The special force, headed by Rear Admiral John T. Babb, a pharmacist, was created by the Surgeon General in 1994 to assist federal, state, and municipal governments when necessary.

When terrorists attacked New York City and the Pentagon on September 11, 2001, CCRF team members were deployed from various agencies of the government to provide disaster relief, Lawrence said.

After letters containing Bacillus anthracis spores were discovered in the mail in October 2001, CCRF officers, including several pharmacists, were deployed to Washington, D.C., and New York City to help provide counseling and dispense antiinfectives to postal workers and others who may have been exposed to the spores, he added.

About 32% of the Commissioned Corps has been trained for deployment with CCRF teams, Lawrence noted.

HHS’s Thompson, he said, has called for 50% of the force’s officers to be trained in emergency response skills, including basic life support, by next year, and all officers trained and deployable by 2005. 

CCRF as “an identifiable entity and system of qualifications will disappear because the entire [Commissioned] Corps will become deployable,” Lawrence said.

“What we are trying to do is train a flexible force that can address pressing public health issues and respond to emergencies on a routine basis.”

Officers may advance their careers in the Commissioned Corps by seeking additional emergency and disaster response training, he added.

The 861 pharmacy officers serving in the Commissioned Corps are “uniquely qualified,” Lawrence said, to participate in advanced emergency response training, such as biochemical decontamination. “Pharmacists come to the party knowing about chemicals and biologicals and are already equipped for this type of training,” Lawrence said.

Commissioned Corps pharmacists, he added, have opportunities to practice in health care environments that “go well beyond the traditional scope.”

As a two-star admiral in the Public Health Service, Lawrence said, he has the opportunity to bring a pharmacy perspective to government when he attends meetings with HHS’s Thompson, the Surgeon General, or other top government officials.

“My pharmacy education is called on everyday,” he said.

As members of the Commissioned Corps, he said, “pharmacists have the opportunity to do everything I’ve done and more.”

PHS has four pharmacy officers who hold the rank of rear admiral: Lawrence; Babb; Rear Admiral Richard M. Church, IHS’s chief information officer; and Rear Admiral Richard S. Walling, PHS’s chief pharmacist officer and director of HHS’s office of global health affairs.

“Our roots are with pharmacy, but we have been able to expand into the larger realm of public health,” Walling said.