DRAFT

PPAC MEETING MINUTES

Thursday August 26, 2004

Room 17-51 Conference Room

ParklawnBuilding

Rockville, MD

CALL TO ORDER: CDR Sarah Linde-Feucht called the meeting to order at 1300 hrs.

ATTENDEES:

RADM Craig Vanderwagen, Chief Professional Officer

CDR Sarah Linde-Feucht, Chair

LCDR Sarah Atanasoff, Vice Chair

LCDR Jeff Brady

CDR Katy Ciacco-Palatianos

^ CDR Marsha Davenport

^CAPT Van Hubbard

CAPT Newton Kendig

^CAPT Virginia Lee

Saralyn Mark

^LCDR John Redd

GUESTS:

CDR Mike Boquard

CDR Mike Carome

^CDR Carol Freidman

^David Frucht

^John Harten

^CDR Sonja Hutchins

Jeffrey Kopp

^CDR Ram Koppaka

^Brian Lewis

*^CAPT Vern Maas

^Matt Moore

^CDR Robert Newman

^Jeff Niemhauser

^CDR Monica Parise

Calman Prussin

^CDR Jeff Salvon-Harman

^Jeremy Sobel

CDR Carolyn Tabak

^Darius Yorichi

CDR Stephanie Zaza

^ Indicates attendance by telephone

EXCUSED MEMBERS:

LCDR Rochelle Nolte, Executive Secretary

CDR Rosemarie Hirsch

CDR Dahna Batts-Osborne

CDR Ana Maria Osorio

CAPT Susan Molchan

CAPT Steve Rosenthal

APPROVAL OF MINUTES:

The minutes from the previous PPAC meeting were approved.

SGPAC/CPO/PAC CHAIR MEETING8/26/04 Report:

  • The Office of Commissioned Corps Operations (OCCO) and the Office of Commissioned Corps Force Management (OCCFM) have moved from the Parklawn building to the TowerBuilding.
  • CPO vacancies have not been filled due to administrative/policy issues. Until these issues are resolved, vacancies (and opportunities to fill them) will not be announced.
  • Changes within HHS organization have occurred. The Office of Global Health Affairs and the Federal Occupational Health Service have become staff divisions.
  • The Office of Science and Communications announced the release of various public health reports, and upcoming Surgeon General Workshops. Topics include Osteoporosis, Child Maltreatment, Global Health, Women and Mental Health.
  • CC Officers should include their rank to identify their affiliation with the PHSCommissioned Corps on correspondence (electronic and written).
  • The Medical Reserve Corps has approximately 27,000 volunteers.
  • RADM Vanderwagen summarized the details of the Secretary’s (HHS) initiative of augmenting and reorganizing the Indian Health Service (IHS).
  • RADM Knouss gave an update on Transformation noting a growing momentum of activities, an effort to replace the pay and compensation system, an effort to increase public awareness regarding the Corps, plans to develop a policy on the Warrant Officer Corps, issues regarding the transition to TRICARE with regard to reimbursement, provider access, and officers located in remote locations and plans to solidify training opportunities with the Veterans Administration.
  • Regarding the Transformation of the Corps, the Lewin Group has produced a preliminary report. A Transformation working group has also been established comprised of agency and staff office representatives. This group is outlining the main issues of the transformation as well as options to present to the Secretary. The four main issues are 1) force management, 2) training and development, 3) communications, and 4) budgeting.A specific example of a Force Management issue is How is the Corps best served by grouping personnel by category and/or by function. The group will outline the pros and cons of each options and plan to present these options for the Secretary to consider by the end of September 2004. These options were described as the 30,000 ft. perspective for upper level leadership.
  • It was recognized that there is a need to enhance the clinical abilities of the Corps while still meeting agency missions, such as a prominence in scientific work. There is a continued emphasis on emergency response.
  • COERS are due to go out next week.
  • A CPO retreat was also held and attended by the CPO Board. RADM Vanderwagen reviewed some of the topics of discussion at this meeting.
  • The meeting was facilitated by Pal Littleton, USPHS Retired.
  • The focus of the meeting was on interdisciplinary issues not issues unique to particular categories.
  • Various topics were also discussed from an operational perspective.
  • Plans were made to discuss issues with high-level managers at agencies served by the PHS CC.
  • Plans were made to organize the public health professional organizations (estimated to be approximately 40 orgs. in IHS) to discuss issues with the department.
  • Infrastructure issues such as the PHS OCCO and OCCFM staffing issues through the PACs were also discussed.
  • The appointment of new CPOs was also discussed.

PROMOTION:

  • Pay and benefits were discussed in the context of promotion rates from the last promotion cycle (2004).
  • It is recognized that this issue will bear directly on recruitment and retention of medical officers in the future.
  • Estimates of time in service at particular ranks in other uniformed services were provided. For the DoD, it was estimated that a Medical Officer with 12 years of service would most likely have the rank of O5, and with 16 years, O6. Promotion rates for line officers in the US Coast Guard to the rank of O5 was estimated to be 67%.
  • The policy of 3 opportunities for promotion or freezing at the current rank is also predicted to be detrimental to the retention of medical officers.
  • Some comparisons of the CC pay and benefits to alternate employment opportunities such as Title 5 and/or Title 38 were discussed.
  • A plan was discussed for the PPAC to research promotion rates, processes, and timelines for medical/health professional officers in other uniformed services and consider proposing a recommendation for senior leadership to consider differential promotion rates for the medical category, and possibly other categories with a doctoral level qualifying degree that is clinically-based (i.e., Dental, Veterinary). CDR Sarah Linde-Feucht will solicit volunteers via email for a subcommittee to work on this issue.
  • CHAIR ADDENDUM: Subsequent to this discussion, the Promotion Analysis Subcommittee was formed and will be co-chaired by CDR Ana Maria Osorio and LCDR Sarah Atanasoff. Approximately 15 physicians have volunteered to serve on this committee whose charge is to collect and analyze data about promotion rates for physicians in the PHS Commissioned Corps and compare it to promotion rates for physicians in the Army, Navy, and Air Force. In addition, this group will update and analyze the characteristics of physicians in the Corps (# of officers per category, # of docs per agency, # of docs per rank, # of officers by geographical distribution, and gender distribution of medical officers). The data will be reviewed and discussed at a future PPAC meeting. This data may serve as the basis for preparing a paper to the Surgeon General about Issues for Consideration regarding Promotion in the Medical Category of the PHS Commissioned Corps.
  • A question was asked about how to justify differential promotion rates for medical officers who have positions that don’t require a medical officer. Briefly, the discussion centered on the value added that a medical officer with clinical training and/or experience would offer in many cases.
  • The policy for assignment of ranks within the Inactive Reserve was discussed. It has been observed that ranks and/or rates of promotion are higher in the inactive reserve as compared to the active duty PHS CC. Mr. Jim Sayers was identified as a resource for further information on this topic.
  • CDR Sarah Linde-Feucht solicited information from the group about any systemic issues that were observed in the past promotion cycle.
  • It was recognized that a focus on PHS retention is missing from the promotion policies.
  • Interest was expressed to reinvigorate the mentoring program for career development. CDR Sarah Linde-Feucht announced she would solicit volunteers for a Mentoring subcommittee.
  • CHAIR ADDENDUM: Subsequent to this discussion, the Mentoring Subcommittee and will be chaired by CAPT Steve Rosenthal. This committee would identify and develop ways in which the PPAC and interested physicians can best serve officers in the medical category.
  • A question whether the example CV format provided on the PPAC website is the required format or just a suggested format. (the answer is the latter)
  • Interest was expressed to better understand the process (in more detail) undertaken by promotion boards.
  • An interest was expressed in promotion boards providing better feedback to officers.

READINESS:

  • The monthly readiness report has been provided by the Office of Force Readiness and Deployment (FRD).
  • At 9%, the medical category has the lowest rate of readiness among the PHS categories. This rate was 18% last month. Part of the reason for the drop in the readiness numbers across all categories is the current implementation of the new Manual Circular 377 which has different readiness standards compared to the formerly used MC 375.
  • The goal is for 50% of ALL officers to meet basic readiness requirements by September 30, 2004.
  • All officers are encouraged to log in to the FRD (formerly CCRF) website to check their readiness status and to fulfill any missing requirements.
  • The PPAC will not be contacting officers individually to inform them of their readiness status but has contacted officers via the PPAC email distribution list which is circulated to more than just PPAC members.
  • An information sheet about Readiness has been developed by the Pharmacy category. In the near future, some version of this information sheet may be posted on the PPAC website to assist officers in determining missing readiness requirements.

CHARTER REVIEW SUBCOMMITTEE REPORT:

  • A brief report of the PPAC Charter Review Subcommittee was presented.
  • After limited discussion, it was decided to post-pone the PPAC’s vote to accept the subcommittee’s recommendation that the PPAC renew the existing charter (with minor format and typographical corrections).
  • Subcommittee members expressed an interest that PPAC members be provided an opportunity to review the subcommittee’s written report, which contains a summary of the issues discussed and recommendations for future PPAC efforts to address issues relating to the charter.
  • For further details, please see Attachment 1: Report of the Physicians Professional Advisory Committee (PPAC) Charter Revision and Review Subcommittee.
  • CDR Linde-Feucht is to contact the Surgeon General to set up a follow-up meeting to discuss some of the outstanding issues.

PPAC BYLAWS:

  • CDR Mike Boquard presented for the PPAC’s consideration, bylaws for PPAC membership that were drafted as a follow-on to discussions of the charter review subcommittee.
  • For further details, please see Attachment 2: (SAMPLE) BYLAWS OF PHYSICIANS PROFESSIONAL ADVISORY COMMITTEE 15 July 2004.

RETIREMENT:

  • Prior to the meeting, one officer contacted the PPAC chair about including the topic of retirement on the agenda. This officer was not present at the meeting to discuss. In addition, it was noted that the COA is working on that particular issue so the PPAC did not address the issue further.

PHS MOTTO:

  • Please send suggestions to RADM Bob Williams.
  • Carol Friedman suggested, “Respond, Protect, Take Action,” as a PHS motto.
  • Sarah Linde-Feucht suggested, “Doc’s Rock!” but noted in good humor that this motto applies only to the medical category and not to all officers in the Corps.

NEXT MEETING:

  • October 28, 2004, location TBD.

ADJOURNED:

CDR Sarah Linde-Feucht adjourned the meeting at 1505.

Respectfully submitted,

LCDR Jeff Brady,

for

LCDR Rochelle Nolte

PPAC Exec Sec

ATTACHMENT 1

Report of the Physicians Professional Advisory Committee (PPAC)

Charter Review and Revision Subcommittee

August 16, 2004

Summary

The Charter Review and Revision Subcommittee of the Physicians Professional Advisory Committee (PPAC) was formed at the PPAC meeting on June 24, 2004. The subcommittee was charged with the task of completing the periodic review and revision of the PPAC charter. As part of this process, the currently active PPAC charter, dated November 2002, was distributed for review to subcommittee members, along with “Guidelines and Procedures for the Professional Advisory Committees/Chief Professional Officers” (Office of the Surgeon General, July 2001, modified March 4, 2002). Preliminary discussions were held, and issues for discussion were raised via email, in advance of a teleconference with members of the subcommittee. A teleconference was held on July 8, 2004, in which the PPAC charter was reviewed and discussed, in light of a collection of issues related to the charter.

Participation

The following officers participated in the work if this subcommittee:

LCDR Sarah Atanasoff

CDR Michael Boquard

LCDR Jeff Brady, chair

CDR Carol Friedman

CDR David Frucht

CAPT Vern Maas

Dr. Saralyn Mark

LCDR Rochelle Nolte

Conclusions

The subcommittee recommends no revisions to the charter. The current PPAC charter is based on the model charter, which is included as part of the “Guidelines and Procedures for the Professional Advisory Committees/Chief Professional Officers”. No significant differences were noted between these documents.

However, following its review and discussion of revision of the PPAC charter, the subcommittee has generated a list of items for further consideration by the entire PPAC. For some issues, definitive recommendations are not provided, even though revision of the charter may ultimately be the most appropriate action. In these cases, the subcommittee has deferred recommendations to revise the charter until more information, such as direction from the Surgeon General, is available. Additionally, significant revisions to the PPAC charter may be premature in advance of additional information related to the transformation of the Commissioned Corps.

The subcommittee agrees that other issues could be addressed within the scope of the current version of the PPAC charter. In some cases, the subcommittee considered the PPAC’s option of addressing particular issues by drafting bylaws to document and to clarify particular aspects of a suggestion or recommendation. This is within the scope of the PPAC’s authority, as the current charters (model charter and PPAC charter) provide for the establishment of bylaws under the section entitled, “Operations and Procedures.” The “Guidelines and Procedures…” document also directs each PAC to “develop its own specific internal operations and procedures (e.g., bylaws) as described in the model charter.”

Discussion

Several issues were raised and discussed in some detail during the course of the subcommittee’s review. These issues along with various considerations and the group’s consensus recommendations are summarized as follows:

  1. The Surgeon General's (SG) expectation for the purpose/scope of the PPAC
  • As an advisor to the SG, the SG's perspective of the PPAC's mission is the major determinant of the PPAC's focus.
  • This question has been addressed, in part, through a meeting with the Surgeon General and the PPAC in late Spring 2004.
  • As the Commissioned Corps continues to undergo transformation, the SG’s perspective on the role of the PPAC and the PACs in general may also change, and ongoing discussions with the SG to update the PPAC will be helpful.
  • Future changes in the model charter for PACs that come about as a result of transformation or for other reasons should also provide clear insight into the perspective of the Commissioned Corps Leadership on the specific mission of the PACs.

RECOMMENDATION: Seek opportunities to elaborate the PPAC’s understanding of the SG’s expectation for the purpose/scope of the PPAC. Ensure PPAC representation and encourage active roles in initiatives such as revision of the model charter for PACs, as they arise.

  1. The scope of the PPAC's mission related to the professional practice of Civil Service (CS) Physicians
  • The current charter includes the “issues relating to the professional practice and the personnel activities, civil service (CS) and commissioned corps (CC), of the Medical Category” within the scope of the PPAC mission.
  • The charter further requires that, regarding membership, “[t]he PPAC cannot include only CC or only CS.”
  • In accordance with issue 1 listed above, the SG's interest in CS physician issues is the major determinant for this issue as well.
  • The SG's authority in CS physician issues will also bear on this issue.
  • No definite recommendations regarding CS representation on the PPAC resulted from the subcommittee’s discussion.
  • Some questions were raised such as the following: What is the history of CS representation in the past? Why were CS physicians included originally? One answer offered was that CS physicians were included “to answer CS questions that may come up in PPAC meetings.”

RECOMMENDATION: Seek guidance outside the PPAC and engage other PACs to learn from their experiences with CS issues.

  1. The organization of the PPAC
  • The organization of the PPAC is an issue that is closely related to the PPAC membership (issue #4, below).
  • An observation was made that the standing or permanent subcommittees of the PPAC are structured around PPAC work that is ongoing or recurring on an annual or more frequent basis.
  • In reviewing both the organization of the PPAC and issues related to PPAC membership, the impact of any proposed changes should be considered carefully. For example, proposals that change the duration of membership should consider the potential impact on the availability of officers with relevant experience to assume leadership roles within the PPAC.

RECOMMENDATION: Conduct a periodic review of standing subcommittees, officers assigned to them, and responsibilities and goals. Consider adoption of the “PPAC Affiliate Member Program” (summarized below *).

  1. PPAC membership
  • The subcommittee recognized an increased incentive for PPAC membership and participation that has resulted from the inclusion of PPAC participation as a medical category promotion benchmark.
  • Various strategies were discussed to increase PPAC participation, including increased utilization of existing opportunities for participation in addition to the creation of novel opportunities.
  • Expansion in membership may require additional PPAC administrative resources to track and to manage the status of members.
  • Various membership roles should be developed with explicit criteria for participation. Requirements for “active membership” and requirements for awards (special assignment awards) should be clarified.
  • The standard length of service for members was discussed. Although 2 three-year terms of voting membership may be more common currently, the subcommittee discussed the idea to encourage officers to transition from voting membership to ex-officio membership after a 3-year term. This would enable more officers to serve on the PPAC in a voting capacity.
  • The subcommittee recognized that flexibility should remain in the length of service on the PPAC to accommodate certain situations. For example, it may be beneficial or necessary for candidate/selectee for the chairmanship of PPAC to serve two consecutive terms.
  • The subcommittee identified the lack of a requirement for the Executive Secretary to be a voting member. In the future, this may potentially create an opportunity for a motivated officer to serve in this capacity without serving as a voting member.
  • The PPAC could expand the capacity for ex-officio membership as provided for in the charter.
  • The position of Liaison member is included in the charter.
  • Expand the “alternate” role as provided for in the charter as a means to expand membership opportunities and participation.
  • According to the charter, only the chairpersons of subcommittees are required to be voting members of the PPAC.

RECOMMENDATION: The PPAC should consider expanding existing programs or initiating novel mechanisms to increase the opportunity for official/documented PPAC participation. In addition, the PPAC should carefully consider the potential impact of any proposed changes in its membership on its mandate to represent the medical category according to agency, geography, rank, seniority, specialty, and other factors.