Physicians’ Professional Advisory Committee

Annual Retreat Minutes

March 18-19, 2004

5600 Fishers Lane (ParklawnBuilding)

Room 6A-55 Conference Room

Rockville, MD

CALL TO ORDER

CDR Sarah Linde-Feucht called the meeting to order at 1300hours.

ATTENDEES:

*CDR Dahna Batts-Osborne

CDR Marsh Davenport

CAPT Newton Kendig

CDR Ana Maria Osorio

CAPT Lynn Bosco

CAPT Virginia Lee

CDR Sarah Linde-Feucht

CDR Graciela Gonzalez

CDR Rosemarie Hirsh

Saralyn Mark

CDR Katy Ciacco-Palatianos

CAPT Van Hubbard

CAPT Eric Mann

LCDR Rochelle Nolte

CAPT Steven Rosenthal

CDR Sara Atanasoff

*LT Daisy Eng

CAPT Susan Molchan

LCDR Jeff Brady

^CDR Joannie Shen

^CDR Ram Koppaka

^CAPT Thurma Goldman

*^CDR Robert Newman

^CDR Shirley Lee-Lecher

  • *Denote participation by telephone
  • ^ Denotes guest

REVIEW OF RETREAT AGENDA

CDR Linde-Feucht reviewed the retreat agenda, and opened the retreat by reading the mission statement in the PPAC Charter. The Charter is due for its 2 year review. After discussion, it was decided that the charter review should be put off until a future meeting so that any changes that might come about as a result of the retreat could be accommodated.

**Action Item: All PPAC members are to review the charter prior to the formal review and the vote to accept the current charter, or revise it.

2003: YEAR IN REVIEW

CDR Davenport read her PPAC Annual Report (see attached full report). 2003 was a very busy year for the PPAC. In addition to acting as PPAC chair, CDR Davenport served as acting CPO, while RADM Vanderwagen was deployed to Iraq. The PPAC was very active in addressing the issues associated with transformation, including reviewing promotion precepts and deployment readiness issues. The PPAC compiled responses from many officers in order to prepare its responses to DCP on the proposed personnel changes. 2003 was the most active and most visible year yet for the PPAC. Please see the attached report for details.

2004: THE YEAR AHEAD

CDR Linde-Feucht presented her vision of the PPAC as a venue to represent physicians and facilitate communications both among physicians, and between physicians and other disciplines, as well as communication from physicians to our leadership, and from our leadership to physicians. The PPAC also has a role to advise the Surgeon General on issues of interest to physicians. It was suggested that the minutes from our meetings be forwarded to the SG.

CDR Linde-Feucht challenges the Commissioned Corps physicians to set examples of good officership by becoming involved in various activities whether it be PPAC, CCRF, DMAT, Associate Recruiter Program, mentoring, or volunteering to sit on a review board.

Something the PPAC has not done extensively in the past, but may begin doing is developing position statements. CAPT Thurma Goldman pointed out that the PPAC may want to support the position of the physician CPO (actually Deputy CPO, as the SG is the physician CPO) be funded as a full-time billet. Apparently, this is the case for some of the other categories.

PPAC BUSINESS MEETING

CDR Hirsh made a motion to approve the minutes from the last meeting. Motion was seconded by CAPT Lee and passed unanimously.

Saralyn Mark inquired about the invitation to ADM Carmona to attend one of our meetings. As he was unable to attend the meetings he was invited to, there was discussion about possibly adjusting a future meeting to accommodate his schedule.

1)SGPAC/CPO/PPAC Chair Meeting Highlights

-RADM Moritsugu encouraged officers to become more involved by participating in various activities in support of the Corps.

-The fitness standards for officers were discussed

-CDR Gilbert Rose was seeking nominations for AMA young physicians’ award (due by March 10th)

-OSG is seeking subject matter experts to volunteer to assist in speech-writing (seeking subject matter experts, not speech writers). Please contact CDR Gilbert Rose

-105th Interagency Institute course (2 weeks) will be held in WashingtonDC in April.

-RADM Moritsugu recognized DCP for getting 100% of faxed documents into OPF’s for this promotion cycle.

-CDR Hirsch asks that the PPAC request DCP increase the number of lines into DCP during high usage times, as getting a document into the fax queue was no easy task during the last promotion cycle. Discussion from many other officers confirmed that this was a common complaint of officers trying to get documents to DCP during the last promotion cycle

-The shift to Tricare was discussed at the SGPAC/CPO meeting

2)COMMITTEE UPDATES

CDR Linde-Feucht reviewed the official committees and their membership. The membership, as well as the committees themselves may be changing after this retreat.

A)PPAC Membership

CAPT Mann reported that the membership of the PPAC is on track with appointment and re-appointment letters. The call for nominations will go out in June this year to facilitate getting the applications through and all the appropriate signatures before the official start of the term on January 1. There are at least 4 anticipated vacancies, so please encourage previous applicants to re-apply. (the increase in visibility of the PPAC over the last year and the increased interest in serving brought about by the transformation led to 15 applications for the one vacancy last year) There was some discussion about whether the PPAC should continue the current process of having members renew their memberships to serve two 3 year terms or if this should be changed to allow more people to participate now that there is an increased interest in serving on the PPAC.

**Action Item: All PPAC members should ensure they have their appointment letter/ re-appointment letter to be placed in their file/OPF. Contact CAPT Mann for questions.

B) Physician Workforce Survey

CDR Ana Maria Osorio presented the data she has collected on physicians in the Commissioned Corps. (see attached file for data graphs) This initially began with the goal of identifying the physicians so that we could better communicate with them, and ensure that the PPAC was truly representative of the physicians and was able to provide mentoring to medical category officers. CDR Osorio was only able to collect data on Commissioned Corps physicians from 1999 to present. The data collected shows a decrease in total physicians from 1245 in Feb 2002 to 1185 in March 2004, a decrease from 22% to 20% of the total Commissioned Corps. The medical category is also no longer the largest category, as nurses have increased in number from under 1100 to over 1200 over the same period of time. The largest decrease in physicians occurred at NIH and IHS, with HRSA showing a decrease as well.

CDR Osorio noted that it would be useful to see if any of the other PACs are collecting similar information to see if there are any trends across categories. She also recommended that if DCP could be queried for data for prior to 1999, it would be useful to see what the trends have been over a longer period of time. Surveys of people leaving the Commissioned Corps would be helpful in determining why people are leaving and where are they going when they leave. This information could be applied to future recruiting and retention efforts.

In trying to identify the Civil Service physicians, CDR Osorio called each individual OPDIV, but this information was not readily available. CAPT Lee pointed out that civil service physicians may sometimes have job descriptions that are not in the medical category, making them even more difficult to locate.

There was discussion on trying again to gather information on the civil service physician workforce in DHHS. With the new emphasis on readiness and response capabilities, it was thought that the agencies may be more willing to assist with identifying their physician assets (if they haven’t already developed a database.

CAPT Kendig pointed out that if response preparedness is a priority, knowing the current physician workforce in order to identify deficits so recruitment and retention could be appropriately focused would be important.

CDR Davenport pointed out that the PAC chairs now have access to DCP’s database. While there are no summary reports, the raw data is available, and could be queried to get information on officers. Information on physicians in the Commissioned Corps is something the PPAC should have access to in order to ensure appropriate representation of the category and to provide the best advice to the Surgeon General. Establishing better communications with individuals who may be collecting the same information that the PPAC is interested in, such as DCP, the Lewin group, and senior leadership involved with the transformation in the coming year was suggested.

C) Associate Recruiter Program

LCDR Sarah Atanosoff gave an update on the ARP. Penny Coppola will be at the COA meeting in May. Questions came up regarding recruiting in the face of the transformation. Without knowing what the projected future physician workforce is envisioned to look like and not knowing what the projected deficits are, it is difficult to focus recruiting. CDR Hirsh pointed out that having information available on the Commissioned Corps and Civil Service jobs would be helpful in recruiting so potential applicants could evaluate the two systems and make more informed decisions. There was some discussion of making this information available on the PPAC website.

D) PPAC Website

CAPT Virginia Lee has been acting as webmaster of the website, which can be reached through a link from DCP’s website. If anyone has ideas for the “highlights” section of the website, please forward your ideas to CAPT Lee.

The website address is:

E) PPAC Listserv

CAPT Rosenthal reported that despite only 10% of Commissioned Corps officers being signed up for the listserv, important information seems to be getting disseminated. However, the question was raised about making an effort to reach more of the physicians directly through the listserv. It was suggested to ask CAPT Canton of DCP if CDR Linde-Feucht could send an e-mail to all of the Commissioned Corps physicians inviting them to sign up for the listserv and giving them all the PPAC website address.

3)ISSUES FOR PHYSICIANS

Discussion on Chart Review and Disclosure by CAPT Lois Steele, and LCDR Jeffrey Salvon-Harmon’s MedStep Proposal were both postponed.

A)Privileges: CAPT Van Hubbard brought up an issue that was brought to his attention by CAPT Rick Niska. While federal physicians are all fully credentialed, many do not have current privileges at a fixed facility, especially those in non-clinical billets and those that only see outpatients. Dr. Mark brought up the Medical Reserve Corps and CAPT Newton brought up the Federal Credentialing Initiative as other organizations that may be considering this issue. CAPT Hubbard also suggested RADM Babb as someone to ask about this issue.

B)COA Membership Survey: CAPT Rosenthal sent out 250 surveys and received 30 back in his attempt to survey Commissioned Corps physicians about membership in COA. The physician category has the lowest percentage of membership at 44%. He has forwarded the information he gathered to COA. Discussion about why physicians do not belong to COA (have to belong to too many other professional societies, meeting does not have any clinical CME, officers in field feel detached from the Commissioned Corps, joining through the internet was not easy,etc). Some suggestions about how to advertise the COA to physicians to make it more relevant to them included having COA membership suggested in the e-mail that CDR Linde-Feucht hopes to send to all physicians pending approval from CAPT Canton, putting information about COA and how to join on the PPAC website, and advising physicians that leadership/officership opportunities provided by becoming involved in COA can assist with promotion.

C)FDA PAC: CDR Linde-Feucht announced that the FDA was forming a PAC and she would like a PPAC representative to serve on the FDA PAC as well. CAPT Rosenthal, CDR Osorio, and LCDR Brady all expressed interest and willingness to serve. CDR Davenport also noted that the CDC was developing a PAC as well.

D)Pay parity/Special Pay/Retirement: CAPT Bosco has looked into retirement issues and found that there was a lack of retirement seminars. When she went to look up information in the circulars, she found that they were last updated in 1987 and 1991. Recommendations include:

1.Recommend to DCP that the retirement pay circulars be updated

2.Recommend to DCP the number of retirement seminars be increased

3.Recommend PPAC members from different agencies advertise their respective agencies’ retirement seminars to officers in other agencies. That way an officer whose agency’s retirement seminars are full may be able to attend a retirement seminar at another agency that is still open.

Dr. Mark also added that information on pay and retirement issues for Civil Service physicians would be helpful.

E)Support of Docs in the Field: CDR Ciacco-Palatianos brought up the importance of communicating with physicians in the field. It is hoped that with the new listserv and website that communicating with physicians in the field will become easier.

F)Mentoring: CDR Davenport pointed out that the PPAC’s role will change as DCP’s role changes. The PPAC may become much more instrumental in mentoring physicians. CAPT Newton recommended that a PPAC representative be present at the BOTC course, as officers are now being directed to their PAC’s for career-development and mentoring issues.

TRANSFORMATION UPDATE BY RADM KNOUSS

RADM Knouss gave an update of the ongoing transformation of the PHS Commissioned Corps. The Division of Commissioned Personnel is changing. There is now an Office of Commissioned Corps Support Services, an Office of Commissioned Corps Operations, and an Office of Commissioned Corps Force Management. The Office of Commissioned Corps Operations reports to the Surgeon General. The Office of Commissioned Corps Force Management reports to the ASH. Secretary Thompson has delegated the responsibility for the transformation to the ASH.

The readiness standards are currently being reviewed, and RADM Knouss anticipates minor changes will be made.

The mission statement of the Commissioned Corps is currently under review.

The PHS Commissioned Corps Council has been established. It consists of the Agency Heads and the ASH. This board is to act as policy advisors for the Commissioned Corps. RADM Knouss pointed out that the direct involvement of Agency Heads in Commissioned Corps issues is a drastic change from how things were done previously.

RADM Knouss mentioned various policies that are being evaluated for changes:

A)The current officer rating system

B)How promotion boards are formed

C)Retention issues

D)Special pays for allied health professionals

E)Policies for long-term details to agencies such as WHO or PAHO. Currently officers retire into the detail, and in the future, the officers would need to return to the Commissioned Corps prior to retirement.

RADM Knouss did state that the recent problems with the review of the promotion benchmarks pointed out a need to be able to better communicate with officers. He mentioned that the development of the recent benchmarks was meant to be an inclusive process with solicited input.

RADM Knouss introduced Paul Hagan and Carol Moore from the Lewin Group. They gave a presentation on the transformation. Their main areas of focus are: force management, recruitment, and training of officers. Many of the questions brought up in their presentation were questions that have been brought up by the PPAC over the past year such as: how do we train new officers?, how do we provide career development?, what are the most important missions of the PHS?, how should officers develop in the new corps?. After their presentation, RADM Knouss pointed out that these consultants were involved in an “idea-generating” process, and not a “decision-making” process.

The initial paper should be done by the end of June 2004, but the process of transformation will continue until the transformation is complete. Some recommendations being generated are expanding BOTC to 2 weeks and having officers complete it as their first 2 weeks on active duty. There is also talk of adding mid-career training opportunities.

Members of the PPAC questions the Lewin groups representatives about how thei were gathering their information. They stated they were using focus groups, and had both senior and junior officer groups that they met with. It was suggested that they consider having a mid-career officers group, as this group is the most affected by the transformation, and will be the senior officers of the new corps.

Other questions raised to RADM Knouss included questions about the emphasis of readiness and response to promotion, questions about the role of non-clinical billets currently filled by PHS officers in the new corps, questions about the budget, and questions about how billets will be managed in the new force management system.