(11) Average Length of Time Physician Positions Remained Unfilled: The time should be reported in
months as of the end of the fiscal year (e.g., as of the end of the prior fiscal year the average length of
time vacant physician positions remained unfilled might be 13 months, and for the current fiscal year it
may have declined to an average of 8 months). Only the time during which the agency was actively
searching for candidates should be counted. The total number for all physicians (Part I) and for those
receiving PCA (Part II) should be supplied for each fiscal year. The number by category for each fiscal
year should also be supplied.
ATTACHMENT C
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
WASHINGTON, D.C. 20415
AUG. 8, 1996
OFFICE OF THE DIRECTOR
Honorable Newt Gingrich
Speaker of the House
of Representatives
Washington, DC. 20515
Dear Mr. Speaker:
The purpose of this letter is to transmit a report by the Office of Management and Budget on Physicians
Comparability Allowances (PCA's), as required by section 5948 (j) of title 5, United States Code. The
report was prepared by the Office of Management and Budget using data gathered from those agencies
with approved plans.
The enclosed report describes which agencies have entered into PCA agreements, the recruiting and
retention problems justifying their use, the number of physicians entering into PCA agreements, the size
of the allowances provided and the duration of the agreements, and the degree to which recruiting and
retention problems are alleviated by the allowance.
Sincerely,
/S/
James B. King
Director
Enclosure
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
WASHINGTON, D.C. 20415
AUG. 8, 1996
OFFICE OF THE DIRECTOR
Honorable Albert Gore, Jr.
President of the Senate
Washington, DC. 20510
Dear Mr. President:
The purpose of this letter is to transmit a report by the Office of Management and Budget on Physicians
Comparability Allowances (PCA's), as required by section 5948 (j) of title 5, United States Code. The
report was prepared by the Office of Management and Budget using data gathered from those agencies
with approved plans.
The enclosed report describes which agencies have entered into PCA agreements, the recruiting and
retention problems justifying their use, the number of physicians entering into PCA agreements, the size
of the allowances provided and the duration of the agreements, and the degree to which recruiting and
retention problems are alleviated by the allowance.
Sincerely,
/S/
James B. King
Director
Enclosure
Presidential Report on the Physicians' Comparability Allowance
Introduction
Public Law 103-114 requires the President to report to Congress on the operation of the Physicians'
Comparability Allowance (PCA), including information on:
- which agencies use the allowance;
- the recruiting and retention problems justifying these agencies' use;
- the number of physicians receiving the allowance;
- the size and duration of the agreements entered into;
- and the degree to which the allowance alleviates recruiting and retention problems.
To prepare this report, OMB asked all agencies with PCA-eligible physicians to provide data on:
- the number of physicians they employ, the type of work they do (clinical, research, occupational health
or disability evaluation), how many of these are eligible for the bonus and how many actually receive it;
- the average compensation (excluding PCA bonuses) of physicians receiving and not receiving the
bonus, the size of the average PCA bonus, and the size of bonuses provided physicians by category of
work and length of PCA agreement;
- the average number of years of continuous service per physician, the number of accessions and
separations the agency experienced, the number of unfilled physician positions and the average length of
time these positions were vacant;
- descriptions of the work done by their physicians receiving PCA, and the recruiting and retention
problems justifying payment of PCA bonuses.
Using these data, the report describes the use of the PCA bonus by Federal agencies. It also addresses
the Federal physician recruiting and retention situation, and the effectiveness of the bonus in improving
the situation.
Background
The Physicians' Comparability Allowance authorizes agencies documenting severe recruitment and
retention problems to pay annual bonuses to physicians, up to $14,000 per year for physicians with less
than two years Federal service and up to $20,000 for physicians with more than two years Federal
service. The PCA was originally authorized by P.L. 95-603 in 1978 (5 U.S.C. 5948) and has been
reauthorized a number of times, including 1979, 1981, 1983, 1987, 1990 and 1993. Most of the
reauthorizations were simple extensions of the PCA authority. The 1987 reauthorization doubled the
maximum allowable bonuses to the current levels. The current authority extends to September 30,
1997.
The PCA is authorized only to solve severe, documented physician position recruitment and retention
problems. For the purpose of this allowance, severe recruitment and retention problems are considered
to exist if all of the following conditions exist: long-lasting position vacancies; high turnover rates in
positions requiring well qualified physicians; applicants do not have the superior qualifications necessary
for the position; and existing vacancies cannot be filled with well qualified candidates without use of
PCA.
Federal Physicians Receiving the Physicians' Comparability Allowance
Fiscal Years 1992 to 1996 |
|
FY 1992
(Actual) |
FY 1993
(Actual) |
FY 1994
(Actual) |
FY 1995
(Actual) |
FY 1996
(Est.) |
| Number of Physicians Eligible |
2,977 |
2,942 |
2,987 |
2,913 |
2,936 |
| Number Receiving PCA |
1,869 |
1,891 |
1,885 |
2,015 |
1,952 |
| % of Eligible Receiving PCA |
63% |
64% |
63% |
69% |
66% |
| Average Compensation (PCA Excluded) |
$73,655 |
$78,852 |
$84,604 |
$90,616 |
$91,396 |
| Average PCA |
$14,495 |
$14,694 |
$14,103 |
$16,723 |
$17,334 |
Source: OMB data collection from agencies. Data for FY 1996 = estimated.
Summary of PCA Usage Throughout the Federal Government
As of FY 1995, the last year for which we have complete data, 2,015 physicians in federal employment
received a PCA bonus, out of 2,913 eligible. The average bonus paid was $16,723. The largest users
of PCA were the Department of Health and Human Services, which gave bonuses to 1,193 physicians
and the Department of Defense, which gave bonuses to 480 physicians.
The recruiting and retention problems justifying these bonuses vary widely. Some agencies have
physician personnel difficulties because they require physicians with special expertise such as
aeronautics or agriculture. Other agencies have difficulty because they require physicians to live and
work in remote areas. Still other agencies have difficulties because local competition for physicians has
driven salaries past the standard government pay scale.
The number of physicians receiving PCA has risen slightly from FY 1992 to FY 1995. Estimates for FY
1996 show a slight decline from FY 1995. Their average compensation (excluding PCA) has risen and
estimates for FY 1996 show this rise continuing.
From FY 1992 (actual) to FY 1996 (estimates) PCA has constituted a fairly constant 16% of the
income of those who receive it. The one exception is FY 1994, in which PCA constituted 14% of
receiving physicians' compensation
|
Physicians Signing One Year and Two Year Agreements |
|
|
FY 1992
(Actual) |
FY 1993
(Actual) |
FY 1994
(Actual) |
FY 1995
(Actual) |
FY 1996
(Est.) |
| Signing One-Year Agreements |
Number |
132 |
187 |
175 |
330 |
342 |
| Average Bonus |
$10,673 |
$10,195 |
$10,928 |
$12,104 |
$13,139 |
| Signing Two-Year Agreements |
Number |
1,568 |
1,644 |
1,640 |
1,674 |
1,611 |
| Average Bonus |
$15,338 |
$15,192 |
$15,681 |
$17,909 |
$17,953 |
Source: OMB data collection from agencies. Data from FY 1996 are estimated. Some agencies did not provide all of
the requested data.
Most of the use of PCA has been among physicians signing two-year agreements. The increase in
one-year agreements in FY 1995 is largely due to HHS almost doubling the number of one-year
agreements they made from FY 1994 to FY 1995. Also, in FY 1995 the State Department moved to
one-year instead of two-year agreements.
The data on personnel activity show relatively stable patterns since FY 1992 -- and show that positions
receiving PCA generally have lower turnover than those eligible but not receiving it. In FY 1995,
accessions to positions eligible for PCA were 19% of the total, and separations were 23%. For
positions receiving PCA, accessions were 15% of the total, and separations were 11%.
The percentage of PCA-eligible positions that are unfilled has fallen since 1992, from 13% in FY 1992
to 9% in FY 1995. This decrease appears to be a result of Federal Government downsizing rather than
from an increase in positions filled. As a result of downsizing, for example, HHS has reduced its number
of unfilled positions from 365 in FY 1994 to 174 in FY 1995. (Estimates for FY 1996 show a slight
increase over FY 1995).
National Physician Supply and Salary
Data on the number of physicians in Federal employment by specialty are not available, though
anecdotal evidence and agency reports suggest most are general practitioners. Because this data is not
available, direct comparison of incomes with physicians in private practice is not possible. However, in
1994, all U.S. non-Federal physicians earned an average income (after expenses and before taxes) of
$182,400. Physicians in general or family practice earned an average income (after expenses, before
taxes) of $121,200.1/ In 1994, a total of 653,851 physicians were professionally active in the United
States.2/
1. Source: American Medical Association, "Physician Marketplace Statistics 1995," p.101.
2. Health: United States: 1995; U.S. Department of Health an Human Services; p.220.
| Federal Physicians Separations, Accessions, Unfilled Positions |
| |
FY 1992
(Actual) |
FY 1993
(Actual) |
FY 1994
(Actual) |
FY 1995
(Actual) |
FY 1996
(Est.) |
| Number of Physicians Eligible |
2,977 |
2,942 |
2,987 |
2.913 |
2,936 |
| % of Eligible Receiving PCA |
63% |
64% |
63% |
69% |
66% |
| Accession |
Among Eligible Physicians |
608 |
738 |
684 |
565 |
666 |
| % of Eligible Physicians |
20% |
25% |
23% |
19% |
23% |
| Among PCA Physicians |
294 |
259 |
208 |
294 |
229 |
| % of Receiving Physicians |
16% |
14% |
11% |
15% |
12% |
| Separations |
Among Eligible Physicians |
398 |
735 |
582 |
672 |
653 |
| % of Eligible Physicians |
13% |
25% |
20% |
23% |
22% |
| Among PCA Physicians |
168 |
210 |
162 |
219 |
280 |
| % of Receiving Physicians |
9% |
11% |
9% |
11% |
14% |
| Unfilled Positions |
Among Eligible Physicians |
389 |
483 |
548 |
266 |
302 |
| % of Eligible Physicians |
13% |
16% |
18% |
9% |
10% |
| Among PCA Physicians |
281 |
282 |
310 |
217 |
249 |
| % of Receiving Physicians |
15% |
15% |
16% |
11% |
13% |
Source: OMB data collection
from agencies with approved PCA plans. Data for FY 1996 are estimated. Some
agencies did not provide all of the requested data.
Summary -- Effectiveness of PCA
As the narratives provided below show, Federal agencies employ physicians in a wide variety of
geographic areas to serve multiple functions. This diversity presents federal policy for the recruitment
and retention of physicians with numerous challenges and opportunities. Data show that in FY 1995
accessions, separations, and unfilled positions made up a larger percentage of positions eligible for PCA
than did those actually receiving the bonus. The lower percentage of accessions among positions
receiving PCA is inconclusive, as it could reflect the greater difficulties in recruiting for those positions,
or greater stability in them. The lower percentage of separations among positions receiving PCA
suggests that the PCA may have helped improve retention. The data suggest PCA serves more as a tool
for the retention of physicians than for their recruitment.
Summary of Agency PCA Reports
Agencies with PCA Eligible Physicians
Executive Order No. 12109, signed on December 28, 1978, delegates PCA authority granted to the
President under 5 U.S.C. 5948 to the Directors of the Office of Personnel Management (OPM) and
the Office of Management and Budget (OMB). The following agencies employ physicians eligible for
PCA (listed in descending order of number of physicians receiving PCA in FY 1995):
Department of Health and Human Services
Department of Defense
Department of Justice
Department of State
Department of Transportation
Central Intelligence Agency
US Agency for International Development
Department of Labor
Armed Forces Retirement Homes
Social Security Administration
Environmental Protection Agency
Department of Veterans Affairs
Department of Agriculture
Department of Energy
Department of the Treasury
Library of Congress
NASA
Tennessee Valley Authority
Summary descriptions of their use of the PCA follow.
Department of Health and Human Services
HHS employs the largest number of physicians eligible for and receiving the PCA. HHS reports that
these physicians perform a variety of tasks and possess skills of considerable value outside Federal
employment. For example, the National Institutes of Health, "a worldwide leader in biomedical research
.... recruits physicians with outstanding research competence." It must compete with the academic
community for these physicians. Likewise the Food and Drug Administration must compete with
pharmaceutical companies for physicians qualified to support the regulation of food, prescription and
over the counter drugs, and medical devices. On the other hand, the Indian Health Service provides
clinical care to a large population, much of which is scattered over long distances in remote areas.
In FY 1995, the Department of Health and Human Services (HHS) provided PCA bonuses to 1,193
physicians out of 1,903 eligible. The average bonus was $14,912, and the average compensation (not
including the bonus) of physicians receiving the bonus was $89,590. In the same year, HHS had 205
accessions, 139 separations, and 156 unfilled positions. The average length of vacancy was six months.
Department of Defense
In FY 1995, the Department of Defense provided PCA bonuses to 480 physicians out of 602 eligible.
The average bonus was $11,886, and the average compensation (not including the bonus) of physicians
receiving the bonus was $74,906. In the same year the Department had 50 accessions, 62 separations,
and 26 unfilled positions. While the Department did not report the average the average length of
vacancy, this time varied from three months to two years.
Department of Justice
The Bureau of Prisons within the Justice Department employs physicians to provide health care services
to inmates. The Bureau states that these physicians work under difficult conditions such as rigid work
schedules and environments, close contact with a potentially dangerous and violent population,
increased exposure to infectious disease, and negative public perception of correctional work.
In FY 1995, Justice provided PCA bonuses to 181 physicians out of 198 eligible. The average bonus
was $15,700 and the average compensation (not including the bonus) of physicians receiving the bonus
was $106,000. The department reported 40 accessions and 43 unfilled positions in FY 1995, but had
no information on the number of separations.
Department of State
The State Department reports that its physicians working overseas advise diplomatic staff on foreign
policy questions having medical importance, provide medical care for American employees and their
dependents, provide emergency medical support to foreign posts, monitor quality of care in embassy
health units, and maintain liaison with local physicians, hospitals and public health officials. Physicians
working at headquarters oversee the State Department's Medical Program, determine medical
clearances, coordinate and oversee medical evacuations, and provide occupational health services to
headquarters employees. The Department says that recruiting and retaining physicians is difficult
because "government service overseas, with its disruptive elements, threats of personal security,
separation from family, reduction in income, and intellectual and professional isolation, is an unattractive
option for most experienced physicians." Also, physicians working in headquarters have management
skills which make them very attractive to private sector employers.
In FY 1994, the Department of State provided PCA bonuses to 64 physicians, out of 65 eligible. The
average bonus was $17,000, and the average compensation (not including the bonus) of physicians
receiving the bonus was $104,616. In the same year, the Department had three accessions, three
separations, and four unfilled positions. The average length of vacancy was five months.
Department of Transportation
The Department of Transportation reports that the Federal Aviation Administration (FAA) operates an
office primarily concerned with the human element in flight: the pilots, the passengers, the air traffic
controllers, and the entire human support system. FAA provides a wide range of medical, research, and
safety programs to support safety in civil aviation. According to FAA, experienced physicians are
extremely valuable because the agency has focused its resources on fewer, highly qualified physicians.
Even with the PCA, insufficient remuneration continues to be the principal source of physician
dissatisfaction. FAA states that the success it has had in retaining physicians is primarily due to their
personal interest in aviation and a sense of public service, but without PCA, the difference in salary rates
could negate these other considerations.
In FY 1995, the Department of Transportation paid PCA bonuses to 38 physicians, out of 38 eligible.
The average bonus was $20,000 and the average compensation of physicians (not including the bonus)
was $83,837.
Central Intelligence Agency (CIA)
The CIA reports that it requires PCA pay to attract and retain physicians because of specialized
security and travel requirements. In FY 1995, the CIA paid PCA bonuses to all 25 eligible physicians.
The average bonus was $19,040 and the average non-PCA compensation of the physicians receiving it
was $94,170. The CIA reported two accessions, two separations, and 13 unfilled positions in FY
1995.
U.S. Agency for International Development (AID)
According to AID, one of the reasons for its difficulty in recruiting physicians is the agency's need for
physicians with highly specialized skills. Specific expertise is required in such areas as epidemiology,
preventive medicine, international health, tropical medicine, and infectious disease. These technical skills
often must be combined with management/administrative skills and a knowledge of international
development, as well as interpersonal skills and stature to interact with developing-country colleagues.
According to AID, the agency is at a serious financial disadvantage in competing for such physicians
compared to international agencies such as the World Health Organization.
With so few physicians working for AID, the workload is especially demanding and difficulty retaining
staff is directly related to demands made on AID physicians.
In FY 1995, AID provided bonuses to all eligible physicians, a total of eight. The average bonus was
$19,260, and the average compensation (not including the bonus) of physicians receiving PCA was
$86,984. In FY 1995, AID had two separations and one unfilled position; the average length of
vacancy for physician positions was five months.
Department of Labor
DOL reports that it uses the PCA in hiring physicians for the Office of Worker's Compensation
Programs (OWCP). Because of OWCP's unique requirements, it has been traditionally difficult to
recruit physicians who are qualified and interested in this type of work. Past recruitments indicate that
the OPM Medical Officer registers do not include candidates with the experience and knowledge
necessary for OWCP positions. To obtain qualified candidates, DOL has contacted such organizations
as the American Association of Occupational Health Physicians, the American Academy of Orthopedic
Surgeons, local chapters of the American Medical Association, and several medical schools. Most
physicians contacted through these means have declined employment, citing low salary as the main
reason for their refusal. In many instances, these physicians' expected salaries are one and a half to two
times higher than the rate for GS-14, step 1.
In FY 1995, the Department of Labor provided PCA bonuses to eight physicians, out of 11 eligible.
Their average bonus was $15,400, and average compensation (not including the bonus) was $90,225.
The Department had once accession, two separations, and five unfilled position in FY 1995.
Armed Forces Retirement Homes
The Armed Forces Retirement Homes consist of the United States Naval Home (USNH) and the U.S.
Soldiers' and Airmen's Home (USSAH). In FY 1995 the Armed Forces Retirement Homes had ten
physicians eligible for PCA. Of these, eight physicians received the PCA. The USSAH reports that it
needs to pay PCA to attract specialists in the competitive and expensive Washington area.
The USNH reports that due to the nature of the health/medical problems it addresses, staff physicians
require in-depth family practice experience and a thorough understanding of geriatric medicine. Local
physicians with this background and experience make between $150,000 and $200,000 per year. The
local Veterans Affairs hospital hires physicians at $71,000 to $84,000 per year and can award
recruitment and retention bonuses ranging from $15,000 to $45,000.
The USNH hires physicians at $55,000 to $60,000. Even with the PCA, the USNH states that it has
difficulty recruiting the caliber of physician to provide the highest standard of care to USNH residents.
Social Security Administration
Social Security Administration (SSA) physicians receiving PCA are medical specialists who establish
the medical criteria used to evaluate the severity of medical impairments of applicants for and
beneficiaries of payments under the disability program administered by SSA. The specialists conduct
studies, keep abreast of modern medicine and interface with the medical community to ensure that the
medical criteria of the SSA disability program reflect the latest advances in medicine. Without a PCA,
SSA would not be able to recruit and retain qualified physicians (who must be American Board
Certified and experienced in their specialties) since Administrative medicine is not that attractive to
physicians, especially in SSA where doctors are not integrated into the academic, research or clinical
fields.
In FY 1995, the first year during which the Social Security Administration was separated from the
Department of Health and Human Services, SSA provided PCA bonuses to seven physicians out of 11
eligible. Their average bonus was $14,285, and average compensation (not including the bonus) was
$92,112. SSA had two separations and no accessions or unfilled positions in FY 1995.
Environmental Protection Agency
In FY 1995, the Environmental Protection Agency provided PCA bonuses to six physicians out of
seven eligible. The average bonus was $15,583 and the average compensation (not including the bonus)
of physicians receiving the bonus was $85,978. The department reported one accession and no unfilled
positions or separations in FY 1995.
Department of Veterans Affairs
While physicians working in Veterans hospitals are paid in a separate pay system, the Department does
employ some physicians who are paid according to the General Schedule. These physicians may be
eligible for the PCA. In FY 1995 the Department of Veterans Affairs provided PCA bonuses to two
physicians, out of two eligible for the bonus. The average bonus was $20,000, and the average
compensation (not including the bonus) was $96,990. In FY 1995, the Department had one accession,
one separations, but no unfilled vacancies.
Department of Agriculture
USDA reports it has one employee, working for the Agricultural Research Service, who receives PCA.
USDA says it has had difficulty filling this post, which requires a physician, who is also a human nutrition
researcher. Qualified applicants have not been willing to locate to the USDA facility in North Dakota. In
addition, the University of North Dakota, the chief competitor for physicians and researchers in this
area, pays salaries considerably higher that the GS - GM 15 salary for this position.
In FY 1995, USDA paid a PCA bonus of $20,000 to the physician, whose other compensation was
$92,058. USDA had no separations, and no unfilled positions, in FY 1995.
Department of Energy
The Department did not provide a PCA bonus to any of its three eligible physicians in FY 1995. In the
same year, it had no accessions, separations, or unfilled positions.
Department of the Treasury
In FY 1995 the Department of the Treasury did not provide a PCA bonus to either of its two
physicians eligible for PCA.
Library of Congress
The Library of Congress employs one physician eligible for PCA but does not provide the bonus.
NASA
In FY 1995, NASA employed 28 physicians eligible for PCA but did not provide PCA bonus pay.
Tennessee Valley Authority
In FY 1995 the TVA employed eight PCA-eligible physicians but did not provide PCA bonus pay.
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