Commissioned Corps Transformation

On 18 January 2006, the Secretary of Health and Human Services, Michael O. Leavitt, addressed a standing room only audience in the Department’s headquarters to announce the decisions that he made about transforming the Commissioned Corps of the United States Public Health Service (Corps) into a corps of health professionals ready to meet the challenges of the 21st century. He recognized the commitment his predecessor, Secretary Thompson, made to the Corps and underscored his own desire to strengthen the Corps while reiterating how well the Corps performed during the responses to hurricanes Katrina, Rita and Wilma.

The Secretary’s speech was the culmination of his year-long effort to evaluate the potential of the Corps and how best to advance its capability to address the health needs of the Department and the Nation. During that effort, Secretary Leavitt met with many Corps officers and leaders, Department officials, and private citizens. After meeting with the Department’s leadership, including the Heads of the agencies that employ Corps officers, Secretary Leavitt distributed, on December 5, a memorandum describing his principal decisions. He presented his vision of the Corps as a well trained, highly qualified, dedicated, uniformed service of health professionals who are -

Universally viewed as an essential national resource within the Department of Health and Human Services (HHS) and its agencies to meet critical mission requirements, Ready to respond rapidly to urgent public health challenges and health care emergencies, Available for assignment to address clinical and public health needs in isolated / hardship, hazardous duty, and other difficult-to-fill positions, including when necessary, to address humanitarian, security and defense needs of the Nation, and In this context, sought by departments and agencies at the Federal and State levels for assisting in meeting essential public health leadership and service roles.

After analyzing the Corps’ strength, the Secretary announced that “the first ‘sizing’ objective will be to achieve a force of 6,600 active duty officers. . . It may be possible for the Corps to grow beyond this force strength, particularly as we develop more assignment opportunities in other Federal agencies, at the State and local levels, and in a ready reserve.” A force of 6,600 is about 10 percent larger than today’s total active duty strength. This larger active duty force is intended to meet both the ongoing program needs of the Department and the agencies that it serves and the response requirements for large natural disasters such as hurricanes and earthquakes. Even larger force strengths would be necessary to respond to the consequences of terrorist attacks and other types of public health emergencies with national significance.

In addition to these sizing objectives, the Secretary also presented his decisions, with the support of the Department’s agency Heads, about the force management reforms that the Corps should undertake. By subject matter, they are as follows:

Grouping of Officers Officers should be grouped based on a matrix of professional category (retaining the current description of Chief Professional Officers) and function - Clinical Applied public health Research A new functional group for mental health professionals should be added

Position Identification HHS positions should be categorized as either Corps, civilian or open to either system Criteria to determine which ones should more likely be Corps (or mixed) positions - Provision of clinical services Required for readiness / response Needed for filling isolated / hardship, hazardous duty and difficult-to-fill positions Needed for rotation of officers Needed for training

Billet Content Billet content should be changed to facilitate force management Descriptions should be unique for each position Each billet should contain both general and position-specific information

Billet Approval Process Billet development and approval process should be managed centrally (agency development, central approval with an appeal process to resolve disagreements.) Such a system will require complete understanding of agency requirements and timely action of central Corps management

Isolated / Hardship, Hazardous Duty and Difficult-to-Fill Positions HHS requirements may be met by providing enhanced incentives, rotation opportunities, family support, and, possibly, directed early career assignments Those in established career pathways should not be affected by reassignments

Officer Assignment System Central Corps management should assist agencies in selecting officers by providing multiple, qualified candidates for consideration in filling vacancies New opportunities for utilizing Corps officers need to be arranged with the States, other Federal agencies, particularly in under-served areas, and emphasized by the National Health Service Corps (NHSC) and the Epidemic Intelligence Service (EIS), for example

Allocation of Corps Positions Following determination of Corps size requirements, negotiate with each agency its Corps position allocation, taking into consideration total Corps size requirements and agency determination of positions appropriate for filling by Corps officers.

Training A 2-week Basic Officer Training Course (BOTC) should be required of all new officers at the start of their careers (or within 6 months, if a delay is necessary) Training throughout officers’ careers must be a shared responsibility of the agencies (for their mission) and of the Corps (for “officership” matters)

Recruitment All three recruitment avenues should be used - Pipeline programs Agency recruitment Central recruitment The last having a particularly important role to play Approaches must be consistent, including emphasis on the use of the Corps in assigning scholarship recipients to NHSC and similar programs

Readiness The Office of the Surgeon General / Office of Public Health Emergency Preparedness / Office of Public Health and Science proposal for a four-tiered response capability should be implemented Active duty and reserve Corps officers, including those assigned to non-HHS agencies, should be part of the deployment force Officers who meet critical agency mission requirements should not routinely be deployed except to address the most serious national threats Deployment criteria and roles need to be as specific as possible to assure the best use is made of the capabilities of Corps officers

These decisions represent significant changes from our current system of passive central Corps force management to one in which Corps policy and operations are more active in supporting the Department’s achievement of its objectives.

The Secretary designated Deputy Secretary, Alex M. Azar II, to take the lead in developing the plans for implementing the Secretary’s decisions. Immediately, Deputy Secretary Azar asked the agencies to name representatives to five working groups that would be able to elaborate many of the details for translating the Secretary’s decisions into Corps policies and operations. These work groups have been working since the beginning of January, with support from the Office of Commissioned Corps Force Management, the Office of Commissioned Corps Operations/Office of the Surgeon General, and the Lewin Group, which completed the 2003-2004 study of the Corps. They are concentrating on five sets of decisions. The work groups and their Chairs are as follows:

Size of the Corps (chaired by RADM Sam Shekar); Classification of Corps officers and the billet process (chaired by CAPT Patricia Simone); Assignments for officers (chaired by RADM Eric Broderick); Recruitment and training of officers (chaired by CAPT Kerry Nesseler); and Readiness (chaired by RADM John Babb).

Because the members of the work groups represent key office heads within the Office of the Secretary and agency Heads, the goal is to develop implementation plans that represent a consensus of the Department’s leadership. Therefore, each work group member is asked to assure that the principal official that he or she represents has been presented the work and agrees with the conclusions and recommendations. Moreover, these officials will have an opportunity to express their views before the work group recommendations are redacted into specific Corps force management policies and instructions. Once specific policies have been drafted, there will be another opportunity for agencies to comment.

A coordinating committee (representing the Deputy Secretary, the Assistant Secretary for Health and the Surgeon General) is also meeting weekly to assure that the details for implementation from each work group are consistent both with the Secretary’s decisions and with the recommendations of the other groups. Combined, these groups have 100 officers and many civilian members meeting weekly to develop the plan for implementation of the Secretary’s decisions.

At the same time that this effort is proceeding, the President included in his budget submission to Congress, at the Secretary’s request, $10 million for Fiscal Year 2007 to help meet the additional costs for implementing the Secretary’s force management decisions. Efforts are also underway to identify the new personnel processes that will be needed by central Corps management offices to implement the decisions with efficiency. Furthermore, a communications contract that is already in-place will be used to strengthen public awareness of the Corps and the Corps’ recruitment programs.

The most far-reaching force management changes for the Corps in decades have now been set in motion. More details about these changes will be evolving in the coming weeks and months.

 

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