OMB Bulletin No. 99-03

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OMB Bulletin No. 99-03OMB Home

April 30, 1999

BULLETIN NO. 99-03

TO THE HEADS OF EXECUTIVE DEPARTMENTS AND ESTABLISHMENTS

SUBJECT: Physicians Comparability Allowance Data Reporting Requirements

1. Purpose. This Bulletin, which includes Attachments A through D, provides detailed instructions on data reporting requirements for the Physicians Comparability Allowance (PCA) program. The Bulletin is issued pursuant to the 1998 edition of OMB Circular A-11, section 13.2(b)(12).

Collection of the data by OMB is required to monitor government-wide PCA usage, physician employment, and physician compensation. The data will be used to evaluate the effect of the PCA on Federal physician recruitment and retention and to issue the 1999 Presidential Report on the Physicians Comparability Allowance in accordance with the Federal Physicians Comparability Allowance Act of 1978 Extension (P.L. 105-61).

Later this fiscal year, agencies are also required to submit to OMB for approval a complete description of their plans for implementing the PCA program for fiscal year 2000.

2. Background. On October 10, 1997, the President signed P.L. 105-61, reauthorizing the Federal Physicians Comparability Allowance until September 30, 2000. This Act extends authority to pay annual bonuses for Federal physicians serving in areas or specialties with documented recruitment and retention problems.

Office of Personnel Management (OPM) regulations implementing PCA require OMB approval of agency plans to pay bonuses. OPM regulations implementing the PCA are published in 5 CFR 595.

OMB is collecting data on PCA program operations, as well as on Federal physician recruitment and retention. These data help ensure consistent government-wide implementation and also are used to evaluate the effectiveness of the PCA program.

3. Changes in This Year's Report: Reporting requirements for this year's PCA report are substantially the same as last year's. However, the report includes three new features that should be noted:

(a) Within PCA reporting agencies, organizational components that employed more than 100 physicians who received PCA bonuses during FY 1998, are to submit separate reports (Attachment D PCA worksheets) by component, in addition to a composite report for the Department/agency.

(b) To track PCA trends more effectively, this year's report instructs agencies/components to report overall separations, accessions, and unfilled positions in terms of as well as by number of physicians.

(c) This year's report also seeks agency/component responses to three questions that deal with PCA program operations. The questions are listed at the end of the PCA bulletin (Attachment D).

4. Due Dates. Agencies must furnish the requested PCA information for the 1999 Presidential Report by May 25, 1999.

In addition, agencies are reminded that PCA plan descriptions for FY 2000 must be submitted by September 10, 1999 in the same format as the FY 1999 PCA plans.

5. Termination Date. This Bulletin will terminate as soon as the requested data have been submitted.

Jacob J. Lew
Director

Attachment A

Agencies with currently approved PCA Plans

Department of Defense
Department of Energy
Department of Health and Human Services
Department of Justice
Department of Labor
Department of State
Department of Transportation
Department of Veterans Affairs
Central Intelligence Agency
Environmental Protection Agency
Peace Corps
Social Security Administration

Agencies that have employed or now employ physicians eligible for PCA

Agency for International Development
Department of Agriculture
Department of Treasury
Library of Congress
National Aeronautics and Space Administration
Tennessee Valley Authority
United States Soldiers' and Airmen's Home

NOTE: Agencies not listed that employ physicians eligible for PCA are also covered by this Bulletin.

Attachment B

Physicians Comparability Allowance (PCA) Report and Worksheets

Authority.

5 U.S.C. 5948 authorizes payment of the physicians comparability allowance to eligible individuals paid as physicians under the following pay systems: General Schedule; administratively determined pay for certain specially qualified scientific or professional personnel; Tennessee Valley Authority Act; Foreign Service Act; CIA Act; section 121 of title 2 of the Canal Zone Code; or section 2 of the Act of May 29, 1959, relating to the National Security Agency.

P.L. 100-140, the Federal Physicians Comparability Allowance Amendments of 1987, amended 5 U.S.C. 5948 to provide a maximum PCA of $14,000 per year for physicians with less than 24 months' Federal service, and $20,000 per year for physicians with 24 or more months' Federal service. P.L. 100-140 also allows physician service in the Department of Veterans Affairs and the Public Health Service Commissioned Corps to be creditable towards 24 months Federal civilian service when calculating maximum PCA allowance eligibility. P.L. 105-61 reauthorized PCA until September 30, 2000. Public Law 105-266, the Federal Employees Health Care Protection Act of 1998, authorized an increase in the maximum annual amount of the Physicians' Comparability Allowance from $20,000 to $30,000.

Executive Order No. 12109 delegates authority granted the President under 5 U.S.C. 5948 to the Directors of the Office of Personnel Management and the Office of Management and Budget.

5 CFR 595 sets additional requirements for agency implementation of 5 U.S.C. 5948, including agency reporting requirements.

OMB Circular A-11, 13.2(b)(12), requires agencies to reflect approved plans to pay bonuses in annual budget estimates in accordance with P.L. 100- 140 and P.L. 105-61.

Coverage.

This Bulletin covers all agencies that employ physicians eligible for PCA. This includes both agencies with currently approved PCA plans that are eligible to pay PCA bonuses, whether or not they actually do pay the bonuses, and agencies without approved plans that employ physicians eligible for PCA. Attachment A lists those agencies that currently have an approved PCA plan, as well as agencies that do not currently have an approved plan but which are known-to have employed physicians eligible for PCA based on past experience. Agencies not listed that employ physicians eligible for PCA are still covered by this Bulletin.

Submission Requirements.

(1) Each agency should review and update the 1998 PCA reporting worksheet submitted by that agency. (Copies of the 1998 PCA worksheets have been given to the appropriate OMB staff. Agencies should contact their OMB examiners if they need a copy of the 1998 data.) Please verify that all FY 1995 - FY 1998 figures in the worksheet are correct The latest corrected data for 1995-1998, along with estimates for 1999, should be included in the PCA reporting worksheet (Attachment D of this bulletin). Electronic versions of Attachment D are available from your OMB examiner. More detailed instructions on how to complete the PCA worksheets are included below.

(2) Review the attached copies of the 1998 Presidential Report on the PCA (Attachment C). Verify and update the text for your agency that appears in the section entitled "Summary of Agency PCA Reports," pp. 6 to 11.

(3) Submit the revisions to the 1998 Presidential Report and the updated PCA worksheets to the OMB examiner responsible for your agency by May 25, 1999.

Information Contact: Inquiries should be addressed to Frank Seidl, telephone (202) 395-5146.

Instructions for Preparing Worksheets

General guidance

The data requested should be supplied for all Federal physicians eligible for PCA, and as a subset, all Federal physicians actually receiving PCA. Eligibility for PCA is defined in 5 U.S.C. 5948 and 5 CFR 595.

Data for the budget year should be the estimates included in budget formulation where applicable (e.g., average PCA per physician, average compensation, etc.) or the agency's best estimate (e.g., number of accessions anticipated). Agency estimates may simply be the average of the previous fiscal years. All dollars should be on an obligational basis, and all employment numbers should be on a full-time equivalent (FTE) basis unless otherwise noted.

Several sections of the worksheet request data by physician category. Some agencies may not employ physicians in all categories, but complete data should be provided for those physician categories applicable to the agency.

Definitions-General

Government Physician. 5 U.S.C. 5948(g)(1) defines Government physician as any individual paid as a physician under the following pay systems: General Schedule; administratively determined pay for certain specially qualified scientific or professional personnel; Tennessee Valley Authority Act; Foreign Service Act; CIA Act; section 121 of title 2 of the Canal Zone Code; or section 2 of the Act of May 29, 1959, relating to the National Security Agency.

Creditable Federal Service. For purposes of PCA bonus calculations under 5 U.S.C. 5948, as amended by P.L. 100-140, creditable federal service includes service as a Government physician in any of the personnel systems established under authorities listed immediately above, as well as service as a physician in the Department of Veterans Affairs and the Public Health Service Commissioned Corps.

Definitions-Physician Categories

Category I-Clinical Positions: Positions primarily involving the practice of medicine as a direct service to patients, including the performance of diagnostic, preventive, or therapeutic services to patients in hospitals, clinics, public health programs, diagnostic centers, and similar settings.

Category II-Research Positions: Physician positions primarily involving research and investigative assignments.

Category III-Occupational Health: Physician positions primarily involving the evaluation of physical fitness, the provision of initial treatment of on-the-job illness or injury, or the performance of pre-employment examinations, preventive health screening, or fitness-for-duty examinations.

Category IV-Disability Evaluation and Administration of Health and Medical Programs:

Subcategory IV A: Physician positions primarily involving disability evaluation.

Subcategory IV B: Physician positions primarily involving the administration of health and medical programs, including but not limited to a chief of professional services, senior medical officer, or physician program director position.

Description Worksheets to Be Submitted to OMB

(1) Total Number Employed: The total number of agency physicians eligible for PCA (includes all eligible physicians, whether or not they actually received PCA bonuses) should be supplied for the fiscal years 1995, 1996, 1997, 1998, and 1999 in Part I. The total number of agency physicians actually receiving or expected to receive PCA should be supplied for the fiscal years 1995, 1996, 1997, 1998, and 1999 in Part II. The same data should be provided by physician category for each of the fiscal years.

(2) Number of Physicians Signing One-Year and Two-Year PCA. Under the PCA program, physicians may elect to sign a one-year or two-year PCA service agreement. For those physicians actually receiving or expected to receive PCA (Part II), the number of physicians signing one-year and two-year agreements should be supplied for each fiscal year.

(3) Average Compensation per Physician: Average annual compensation per physician should exclude the PCA bonus, but include base pay and all other bonuses (such as recruitment and relocation bonuses, and retention allowances) and awards. The average compensation for agency physicians eligible for PCA should be supplied for the fiscal years 1995, 1996, 1997, 1998, and 1999 in Part I. The average compensation for agency physicians actually receiving or expected to receive PCA should be supplied for the fiscal years 1995, 1996, 1997, 1998, and 1999 in Part II. The same data should also be provided by physician category for each fiscal year.

(4) Average PCA Amount per Physician, by Category: The average annual PCA bonus paid per physician for all, categories, as well as for each individual category of physician, should be supplied for each fiscal year in Part II.

(5) Average PCA Amount per Physician, by Length of Service Agreement: The average annual PCA bonus paid per physician should be supplied for physicians with a one-year service agreement and two-year service agreement and for each fiscal year in Part III.

(6) Average PCA Amount per Physician, by Length of Federal Service: The average annual PCA bonus paid per physician with (a) less than two years creditable Federal service, and (b) two or more years creditable Federal service, should be supplied for each fiscal year in Part II.

(7) Average Number Years Continuous Service: The average number of years of continuous creditable Federal service as a physician for those eligible (Part I) and actually receiving or expected to receive PCA (Part II) should be supplied for each fiscal year. The average should be calculated as of the end of the fiscal year in question (e.g., for an agency with one eligible physician who began Federal service as a physician under the General Schedule on October 1, 1997, would have one-year creditable Federal service for purposes of PCA for fiscal year 1999).

(8) Number and Rate of Accessions: The total number of accessions and accession rates for all physicians (Part I) and for those receiving PCA (Part H) should be supplied for each fiscal year. The number of accessions by category for each fiscal year should also be supplied. Accession rates are expressed in percentages as the total number of accessions divided by the total number of physicians (both those eligible for PCA and those receiving PCA). Accession rates need not be supplied for each physician category.

(9) Number and Rate of Separations: The total number of separations and separation rates for all physicians (Part I) and for those receiving PCA (Part II) should be supplied for each fiscal year. The number of separations by category for each fiscal year should also be supplied. Separation rates are expressed in percentages as the total number of separations divided by the total number of physicians (both those eligible for PCA and those receiving PCA). Separation rates need not be supplied for each physician category.

(10) Number and Rate of Unfilled Full-Time Equivalent Physician Positions: The number should be equivalent to the total number of physician positions for which the agency has budgeted for the fiscal year in question less the number of physicians on-board during the fiscal year. For example, the agency may have budgeted for 12 full-time equivalent physician positions for the prior fiscal year, but had only 9.5 physicians on-board for the entire year (9 physicians on-board the entire year, and one on-board for six-months of the year). The number of unfilled full-time equivalent physician positions in this case is equal to 2.5.

The total number for all physicians (Part 1) 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.

The rates of total unfilled physician positions should be furnished. Using the example in the paragraph above, the rate of unfilled positions would be 21 percent (or 2.5 unfilled positions divided by 12 positions). Unfilled rates need not be supplied by physician category.

(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 III) should be supplied for each fiscal year. The number by category for each fiscal year should also be supplied.

12 - 14. Additional PCA Program Questions. Agency/component responses may be incorporated in the Attachment D worksheet or, if more convenient, attached separately to the PCA submission.

Attachment C

UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
WASHINGTON, D.C. 20415

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 on Physicians Comparability Allowances (PCAs), 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 and the duration of the agreements, the size of the allowances provided, and the degree to which recruitment and retention problems are alleviated by the allowance.

Sincerely,
/S/
Janice R. Lachance
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 nature and extent of recruiting and retention problems justifying the use of the allowance by each agency;

number of physicians with whom agreements were entered into by each agency;

size of the allowances and duration of the agreements;

and the degree to which the allowance alleviates recruiting and retention problems.

To prepare this report, the Office of Management and Budget (OMB) asked all agencies with PCA- eligible physicians to provide data on:

number of physicians they employ, type of work they do (clinical, research, occupational health or disability evaluation), how many am eligible for the allowance and how many actually receive it,

average compensation (excluding PCA) of physicians receiving and not receiving the allowance, size of the average PCA, and size of allowances provided to eligible physicians by category of work and length of PCA agreement,

average number of years of continuous service per physician, number of accessions and separations the agency experienced, number of unfilled physician positions and average length of time positions were vacant;

descriptions of the physicians' work, and recruiting and retention problems justifying payment of PCA.

Using these data, the report describes the use of PCA by Federal agencies. It also addresses the Federal physician recruiting and retention situation and the effectiveness of PCA in improving the situation.

Background

The Physicians Comparability Allowance authorizes agencies documenting severe recruitment and retention problem to pay an allowance 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 of Federal service. PCA was originally authorized by P.L. 95-603 in 1978 (5 U.S.C. 5943) and has been reauthorized a number of times, including 1979, 1981, 1983, 1987, 1990, 1993, and 1997. Most of the reauthorizations were simple extensions of the PCA authority. The 1987 reauthorization doubled the maximum allowable PCA to the current levels.

PCA is authorized only to solve severe, documented physician 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 PCA. Some agencies use alternative programs to improve recruitment and retention of physicians, such as the Title 38 physician Special Pay authority, that are not covered by this report.

Summary of PCA Usage Throughout the Federal Government

Table 1: Number and Compensation of Federal Physicians Receiving PCA

Federal Physicians Receiving the Physicians Comparability Allowance Fiscal Years 1994 to 1998
	FY 1994 (Actual)	FY 1995 (Actual)	FY 1996 (Actual)	FY1997 (Actual)	FY 1998 (Est.)
Physicians Eligible	2,976	2,917	2,402	2,175	2,149
Physicians Receiving	1,891	2,022	1,841	1,616	1,662
% of Eligible Receiving	64%	69%	77%	74%	77%
Average Compensation of PCA physicians (PCA excluded)	$83,282	$86,220	$88,767	$90,136	$94,039
Average PCA	$14,127	$14,558	$15,764	$15,924	$15,799

Source: OMB data collection from Federal agencies using PCA. Data for FY 1998 are estimated. Some agencies did not provide all of the requested data.

As of FY 1997, the last year for which we have complete data, 1,616 physicians in Federal employment received PCA, out of 2,175 who were eligible. This means that 74 percent of all eligible physicians received PCA. The average compensation in FY 1997 (excluding the PCA) of those federal physicians receiving PCA totaled $90,136 while the average PCA paid was $15, 924. The largest users of PCA were the Department of Health and Human Services, which gave PCA to 808 physicians, and the Department of Defense, which gave PCA to 467 physicians.

The recruiting and retention problems that justify the allowance vary widely. Some agencies require physicians with special expertise such as aeronautics or agriculture. Other agencies require physicians to live and work in remote areas. Still other agencies suffer difficulties because local non-Federal competition for physicians have driven salaries past the standard government pay scale.

The number of physicians eligible for PCA has declined from FY 1994 through FY 1997. In FY 1994, there were 2,976 physicians eligible for PCA, and in FY 1997 that number dropped to 2,175 physicians eligible for PCA. The percentage of physicians receiving PCA has risen from FY 1994 to FY 1996, but declined in FY 1997 by three percentage points. Estimates for FY 1999 indicate that the percentage of physicians receiving PCA will once again increase.

The average compensation (excluding PCA) for physicians receiving PCA has consistently increased over the years, from $83,282 in FY 1994 to $90, 136 in FY 1997. Additionally, the average PCA has increased from FY 1994 to FY 1997 from $14,127 to $15,924. ON average, PCA represents 17 to 18 percent of the average compensation (excluding the PCA) of physicians receiving PCA.

Table 2: Data on Number and Compensation of Federal Physicians by Length of Agreement

Physicians Signing One-Year and Two-Year PCA Agreements Fiscal Years 1994 to 1998
		FY 1994 (Actual)	FY 1995 (Actual)	FY 1996 (Actual)	FY1997 (Actual)	FY 1998 (Est.)
Signing One-Year Agreements	Physicians	175	275	221	218	110
Signing One-Year Agreements	Average PCA	$10,814	$10,129	$11,892	$14,448	$11,811
Signing Two-Year Agreements	Physicians	1,673	1,679	1,614	1,392	1,551
Signing Two-Year Agreements	Average PCA	$15,718	$16,534	$16,982	$16,229	$15,948

Source: OMB data collection from Federal agencies using PCA. Data from FY 1998 are estimated. Some agencies did not provide all of the requested data.

Most of the use of PCA has been among physicians signing two-tear agreements. In any given year, the amount of two-year agreements represents from 86 percent to 91 percent of the total number of agreements being made (excluding FY 1998 estimates). From FY 1995 to FY 1997, the number of one-year and two-year contracts steadily declined. Particularly, the number of two-year contracts being signed decreased significantly from 1996 to 1997 from 1,614 to 1,392, a change of 14 percent. This occurred primarily as a result of an increase in the use of other pay authorities by HHS (the largest user of PCA). FY 1998 estimates predict a 50 percent decrease in the number of one-year agreements and a 10 percent increase in the number of two-year agreements.

Table 3: Data on Accessions, Separations, and Vacancies in Positions Eligible for or Receiving PCA

Federal Physicians Accession, Separation, and Unfilled Positions Fiscal Years 1994 to 1998
		FY 1994 (Actual)	FY 1995 (Actual)	FY 1996 (Actual)	FY 1997 (Actual)	FY 1998 (Est.)
Number of Physicians Eligible		2,976	2,917	2,402	2,175	2,140
Number of Physicians Receiving		1,891	2,022	1,841	1,616	1,662
% of Eligible Receiving PCA		64%	69%	77%	74%	77%
Accession	Among Eligible	686	562	565	316	250
	% of Eligible	23%	19%	24%	15%	12%
	Among PCA	211	294	327	174	191
	% of PCA	11%	15%	18%	11%	11%
Separations	Among Eligible	583	674	629	163	158
	% of Eligible	20%	23%	26%	7%	7%
	Among PCA	103	219	324	123	130
	% of PCA	9%	11%	18%	8%	8%
Unfilled Positions	Among Eligible	560	266	288	258	308
	% of Eligible	19%	9%	12%	12%	14%
	Among PCA	323	217	209	164	202
	% of PCA	17%	11%	11%	10%	12%

Source: OMB data collection from Federal agencies using PCA. Data from FY 1998 are estimated. Some agencies did not provide all of the requested data.

The data on personnel activity show that the number of accessions overall is decreasing. The amount of accessions tends to be higher in the aggregate category of all physicians eligible (which includes both physicians receiving and not receiving PCA) than in the category for physicians receiving PCA. however, the difference in percentage points between the two categories has decreased since FY 1994.

The turnover rate among physicians receiving PCA has generally been lower, specifically from FY 1994 to FY 1996. However, in FY 1997, the turnover rate for physicians receiving PCA was slightly higher than the rate for physicians eligible for PCA. FY 1998 estimates continue this trend.

The percentage of PCA-eligible positions that were unfilled fell from 19% in FY 1994 to 9% in FY 1995, but is now on an upward trend. The percentage rose to 12% in FY 1996, continued at that level in FY 1997, and is estimated to increase to 14% in FY 1998. The decrease in the number of vacant positions in FY 1995 was more the result of Federal government downsizing than an actual increase in positions filled. Overall, the percentage of unfilled position is lower for those physicians receiving PCA.

National Physician Supply and Salary

ln 1996, of the 665,254 professionally active physicians in the United States, 20,429 were in federal service.^1/ Of those 20,429 federal physicians, the highest concentration is located in the specialty areas of Internal Medicine and Family Practice.^2/

Although conclusive data comparing total private and federal physician pay by specialty is unavailable, some information with regards to average net income of physicians is provided below.

For all physicians professionally active in the United States, the average net income (after expenses and before taxes) earned in 1996 totaled $199,000. The median net income amounted to $166,000 and pr esented a 3.8 percent increase from the previous year.^3/

Summary - Effectiveness of PCA

Overall, the data demonstrate that PCA contributes to improved recruitment and retention of Federal physicians. Over the past several years, three-fourths of all eligible physicians have chosen to receive PCA. Particularly, the data show that the percentage of unfilled positions is generally lower for the category of physicians receiving PCA. However, the data also demonstrate that there are other factors outside PCA that have an impact on physicians' decisions to enter Federal service, and therefore on their recruitment and retention. For example, the higher percentage of accessions among physicians eligible for but not receiving PCA demonstrates that physicians choose to enter into Federal service even when not receiving PCA.

As the narratives provided on the following pages indicate, Federal agencies employ physicians in a wide variety of geographic areas to serve multiple functions. This diversity presents numerous challenges and opportunities to Federal policy for the recruitment and retention of physicians. PCA is one of many methods used by Federal agencies to address these recruitment and retention challenges.

1. American Medical Association, Physician Characteristics and Distribution in the US, 1997-98 Edition.

2. Ibid., p. 106.

3. American Medical Association, as cited by: Mary Chris Jakievic, Modern Healthcare, March 30, 1998.

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 1997):

Department of Health and Human Services
Department of Justice
Department of State
Department of Transportation
Central Intelligence Agency
Department of Labor
Armed Forces Retirement Home
Environmental Protection Agency
U.S. Agency for International Development
Social Security Administration
Department of Veterans Affairs
Department of Energy
Department of Agriculture
Library of Congress
Department of the Treasury
NASA
Tennessee Valley Authority

Summary descriptions of each agency's use of PCA:

Department of Health and Human Services (HHS)

HHS employs the largest number of physicians eligible for and receiving PCA. 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" must compete with the academic community to recruit physicians with outstanding research competence. 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. Additionally, the Indian Health Service provides clinical care to a large population, much of which is scattered over long distances in remote areas.

In 1997, the Department of Health and Human Services (HHS) provided PCA to 808 out of 1,138 eligible physicians. HHS attributes the decline in the number of physicians receiving PCA in FY 1997 to the increased use of other pay authorities, such as Physicians Special Pay under Title 38. The average allowance was $17, 469, and the average compensation (not including the allowance) of physicians receiving PCA was $95, 270. Among physicians receiving PCA, HHS had 84 accessions, 54 separations, and 111 unfilled positions. The average length of vacancy was six months.

Department of Defense

In FY 1997, the Department of Defense provided PCA to 467 physicians out of 635 eligible physicians. The average allowance was $12,575 and the average compensation (not including the allowance) of physicians receiving PCA was $77,270. In the same year the Department had 38 accessions, 56 separations, and 23 unfilled positions. While the Department of Defense did not report the average length of vacancy, this time varied from 3 months to 2 years.

Department of Justice

The Bureau of Prisons employs physicians to provide health care services to inmates. 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 1997, Justice provided PCA to 192 physicians out of 203 eligible. The average allowance was $16,200 and the average compensation (not including the allowance) of physicians receiving PCA was $97,000. The Bureau had 42 accessions, 39 unfilled positions, and no separations in FY 1997.

Department of State

State Department 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. According to the State Department, recruiting and retaining physicians is difficult because "government service overseas, with it's 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."

In FY 1997, the Department of State provided PCA to 49 physicians out of 52 eligible. The average allowance was $18, 224, and the average compensation (not including the allowance) of physicians receiving PCA was $97, 816. In the same year, the Department had six accessions, four separations, and three unfilled positions. The average length of vacancy was five months.

Department of Transportation

The Federal Aviation Administration (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 compensation 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 1997, the Department of Transportation provided PCA to all of the 37 eligible physicians. The average allowance was $18,205 and the average compensation of physicians (not including the allowance) was $87,810.

Central Intelligence Agency (CIA)

CIA reports that it requires PCA pay to attract and retain physicians because of specialized security and travel requirements. In FY 1997, CIA paid PCA to all of its eligible physicians. The average was $18,096 and the average non-PCA compensation of the physicians receiving it was $99,544. Of the physicians receiving PCAs, CIA reported 5 accessions, 4 separations, and 9 unfilled positions in FY 1997.

Department of Labor (DOL)

The Department of Labor uses PCA in hiring physicians for the Office of Workers' Compensation Programs (OWCP). Because of OWCP's unique requirements, it has been difficult to recruit physicians who are qualified and interested in this type of work. The Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA) also use PCA agreements to attract and retain physicians needed to provide medical and epidemiological expertise in clinical investigations.

In its efforts to obtain qualified physicians, DOL has contracted such organizations as 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 disinterest. In many instances, the expected salaries of these physicians are one and a half to two times higher than the rate for GS-14, step 1.

In FY 1997, the Department of Labor provided PCA to nine out of 13 eligible DOL physicians. The average allowance paid was $15,444, and the average compensation (not including the allowance) was $89,373. In FY 1997, the Department had four separations, and two unfilled positions.

Armed Forces Retirement Homes

The Armed Forces Retirement Homes (AFRH) consist of the United States Naval Home (USNH) and the U.S. Soldiers' and Airmen's Home (USSAH). In FY 1997 the Armed Forces Retirement Homes had nine physicians eligible for PCA. Of these, six physicians received PCA. The USSAH reports that it must offer PCA to attract specialists in the competitive and expensive Washington area. AFRH had one separation and no accessions in FY 1997.

Environmental Protection Agency (EPA)

In FY 1997, the Environmental Protection Agency provided PCA to all six of its eligible physicians. The average allowance was $15,583 and the average compensation (not including the allowance) of physicians receiving PCA was $85,581. EPA reported no accessions and one separation in FY 1997.

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 areas such 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 in retaining staff is directly related to demands made on AID physicians.

ln FY 1997, AID provided allowances to all seven eligible physicians. The average allowance was $19,142, and the average compensation (not including the allowance) of physicians receiving PCA was $87,078. In FY 1997, AID had one accession, one separation, and one unfilled position; the average length of vacancy for physician positions was five months.

Social Security Administration (SSA)

Social Security Administration 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 PCA, SSA would not be able to recruit and retain qualified physicians (who must be American Board Certified and experienced in their specialties) since physicians are not attracted to administrative medicine, especially in SSA where doctors are not integrated into academic, research or clinical fields.

In FY 1997, SSA provided PCA to five out of eight eligible physicians. The average allowance was $15,000, and the average compensation (not including the allowance) for physicians receiving PCA was $98,207. SSA had no separations and no accessions or unfilled positions in FY 1997.

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 PCA. In FY 1997, the Department of Veterans Affairs provided PCA to both of its eligible physicians. The average allowance was $20,000, and the average compensation (not including the allowance) was $112,069. In FY 1997, the Department had no separations or accessions.

Department of Energy

The Department of Energy provided PCA to one of its four eligible physicians in FY 1997. The PCA compensation was $20,000 and the compensation (not including the allowance) for the physician receiving PCA was $92,142. The Department had one accession, one separation, and two unfilled positions for FY 1997.

Department of Agriculture (USDA)

USDA employs one physician in the Agricultural Research Service. According to USDA, the Department has had difficulty filling this post in the past because it requires a physician who is also a human nutrition researcher. Qualified applicants often are not willing to relocate 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 than the GS-15 salary for this position.

In FY 1997, USDA paid an allowance of $20,000 to the physician, whose other compensation was $96,167. USDA had no separations and no unfilled positions in FY 1997.

Library of Congress

In FY 1997 the Library of Congress employed one physician eligible for PCA, but did not provide PCA.

Department of the Treasury

In FY 1997 the Department of the Treasury employed one physician eligible for PCA, but did not provide PCA.

NASA

NASA is not participating currently in the PCA program. In FY 1997 NASA employed 27 physicians eligible for PCA and had one unfilled position. NASA did not provide PCA to any physicians.

Tennessee Valley Authority (TVA)

ln FY 1997 TVA employed four PCA-eligible physicians but did not provide PCA.

Attachment D

Agency/Organizational
Component

PHYSICIANS' COMPARABILITY ALLOWANCE REPORTING WORKSHEET

	PHYSICIANS ELIGIBLE FOR PCA BUT NOT RECEIVING	PHYSICIANS RECEIVING PCA
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
1) Total Number Employed Category I Category II Category III Category IV-A Category IV-B Total Number Employed
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
2) Number of Physicians Signing: One-Year PCA Two-Year PCA
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
3) Average Compensation per Physician (Excluding PCA) Category I Category II Category III Category IV-A Category IV-B Average Compensation
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
4) Average PCA Amount per Physician Category I Category II Category III Category IV-A Category IV-B Average PCA Amount
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
5) Average PCA Amount per Physician Signing: One-Year PCA Two-Year PCA
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
6) Average PCA Amount per Physician with Federal Service of: Less than Two Years Two or More Years
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
7) Average Number of Years Continuous Service per Physician
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
8) Number and Rate of Accession Category I Category II Category III Category IV-A Category IV-B Total Number of Accessions Accession Rate (for all categories in %)
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
9) Number and Rate of Separation Category I Category II Category III Category IV-A Category IV-B Total Number of Separations Separation Rate (for all categories as %)
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
10) Number an Rate of Unfilled FTEs: Category I Category II Category III Category IV-A Category IV-B Total Unfilled FTEs Unfilled FTE Rate (for all categories as %)
	FY95 FY96 FY97 FY98 FY99	FY95 FY96 FY97 FY98 FY99
11) Average Length of Time (months) Physician Position Vacant

Additional PCA Program Questions:

12) Are physician salary surveys (internal agency, Federal/state/local, or private) used by your agency to help determine who receives PCA bonuses and at what levels, compared to the pay offered by your competitors? If so, please briefly describe the surveys used.

13) How many physicians receiving PCA in FY 1997 and FY 1998, also received recruitment bonuses, relocation bonuses, or retention allowances? Please include the number receiving each of these three bonuses/allowances, as well as the average amounts paid for each in FY 1997 and FY 1998.

14) Of the total physicians receiving PCA in FY 1997 and FY 1998, how many are dentists? What was the average PCA provided to dentists in both years?

AGENCY/ORGANIZATION:
AGENCY CONTACT PERSON:
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