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The web site is no longer updated and links to external web sites and some internal pages will not work.
May 4, 1998
BULLETIN NO. 98-05
TO THE HEADS OF EXECUTIVE DEPARTMENTS AND ESTABLISHMENTS
SUBJECT: Physicians Comparability Allowance Data Reporting Requirements
1. Purpose. This Bulletin, which includes Attachments A through C, provides detailed instructions on
agency data reporting requirements regarding operation of the Physicians Comparability Allowance
(PCA) program. The Bulletin is issued pursuant to the 1997 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 1998 Presidential Report on the Physicians'
Comparability Allowance in accordance with the Federal Physicians Comparability Allowance Act of
1978 Extension (P.L. 105-61).
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 C.F.R. 595.
OMB is collecting data on PCA program operation and Federal physician recruitment and retention to
ensure consistent government-wide implementation and to evaluate the effectiveness of the PCA
program.
3. Due Date. Agencies must submit the requested data by May 29, 1998. FY 1999 PCA Plans must
be submitted by September 15, 1998.
4. Termination Date. This Bulletin will terminate as soon as the requested data have been submitted.
Franklin D. Raines Director
Attachments
ATTACHMENT A
Agencies with currently approved PCA Plans
Department of Defense
Department of Energy
Department of Health and Human Services
Department of Labor
Department of State
Department of Transportation
Social Security Administration
Department of Veterans Affairs
Agencies that have employed or now employ physicians eligible for PCA
Agency for International Development
Central Intelligence Agency
Department of Agriculture
Department of Justice
Department of Treasury
Environmental Protection Agency
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 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.
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 C.F.R. 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 are known to have employed physicians eligible for
PCA. Agencies not listed that employ physicians eligible for PCA are still covered by this Bulletin.
Submission Requirement. (1) Each agency should review and update the 1997 PCA reporting
worksheet submitted by that agency. (Copies of the 1997 data have been given to the appropriate
OMB staff. Agencies should contact their OMB examiners if they need a copy of the 1997 data.)
Please verify that all FY 1994 - FY 1997 figures in the worksheet are correct and add a new column
providing FY 1998 estimates. See below for instructions on how to calculate figures.
(2) Review the attached copies of the 1997 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.
Submit the revisions to the PCA Report and PCA worksheet to the OMB examiner responsible for that
agency.
Information Contact: Inquiries should be addressed to Melany Nakagiri, telephone (202) 3954926.
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 C.F.R.
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 1994, 1995, 1996, 1997, and 1998 in Part 1. The total number of agency physicians actually
receiving or expected to receive PCA should be supplied for the fiscal years 1994, 1995, 1996, 1997,
and 1998 in Part II. The same data should be provided by 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 and awards. The average compensation for
agency physicians eligible for PCA should be supplied for the fiscal years 1994. 1995, 1996, 1997, and
1998 in Part I. The average compensation for agency physicians actually receiving or expected to
receive PCA should be supplied for the fiscal years 1994, 1995, 1996, 1997, and 1998 in Part II. The
same data should also be provided by 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 II.
(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, 1996, would have one-year creditable Federal
service for purposes of PCA for fiscal year 1998).
(8) Number of Accessions: The total number of accessions for all physicians (Part 1) and for those
receiving PCA (Part II) should be supplied for each fiscal year. The number of accessions by category
for each fiscal year should also be supplied.
(9) Number of Separations: The total number of separations 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.
(10) Number 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 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.
(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.
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT'
WASHINGTON. D.C. 20415
JULY 18, 1997
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 (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 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.
The report also recommends a simple 3-year reauthorization of the PCA authority to September 30,
2000. Under the current PCA authority (5 U.S.C. 5948), no PCA service agreement may be entered
into later than September 30, 1997.
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 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 are 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.
Reauthorization of PCA
Under 5 U.S.C. 5948, the current PCA authority extends to September 30, 1997. Based on
information presented in this and previous reports to Congress, PCA has been effective in assisting
Federal agencies to address recruitment and retention problems for physicians. Consistent with these
findings, the Administration supports a simple, 3-year reauthorization of PCA to September 30, 2000.
The simple reauthorization will allow OMB and the Office of Personnel Management (OPM) to
continue to monitor the impact of PCA on the recruitment and retention of Federal physicians.
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. PCA was originally authorized by P.L. 95-603 in 1978 (5 U. S. C. 5 94 8) 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 1evels.
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 f:illed with well-qualified candidates without PCA. Some agencies use
alternative programs to improve recruitment and retention of physicians such as the physician special
pay authority under title 38, United States Code, 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 1993 to 1997
FY 1993
(Actual)
FY 1994
(Actual)
FY 1995
(Actual)
FY 1996
(Actual)
FY 1997
(Est)
Physicians Eligible
2,952
2,975
2.916
2,402
2,580
Physicians Receiving
1,896
1,890
2,014
1,841
1,793
% of Eligible Receiving
64%
64%
69%
77%
69%
Average Compensation (PCA excluded)
$77,777
$83,283
$86.188
$88,761
$90,141
Average PCA
$14,698
$14,124
$14,541
$15,765
$15,373
Source: OMB data collection from Federal agencies using PCA. Data for FY 1997 are estimated.
Some agencies did not provide all of the requested data.
As of FY 1996, the last year for which we have complete data, 1,841 physicians in Federal
employment received PCA, out of 2,402 who were eligible. The average allowance paid was $15,765.
The largest users of PCA were the Department of Health and Human Services (HHS), which gave
bonuses to 1,019 physicians and the Department of Defense, which gave bonuses to 487 physicians.
The recruiting and retention problems that justify the allowance vary greatly. 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 has driven salaries past the standard government pay scale.
The percentage of physicians receiving PCA has risen from FY1994 to FY 1996, but estimates for FY
1997 indicate a decline from FY 1996. The average compensation (excluding PCA) for physicians has
risen consistently over the years, and estimates for FY 1997 indicate this trend will continue. From FY
1994 to FY 1997, PCA has constituted roughly 17% of the income of the physicians who receive the
allowance.
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 1993 to 1997
FY 1993
(Actual)
FY 1994
(Actual)
FY 1995
(Actual)
FY 1996
(Actual)
FY 1997
(Est.)
Signing
One-Year
Agreements
Physicians
187
175
275
221
243
Average Bonus
$10,088
$10,814
$10,129
$11,892
$12,826
Signing
Two-Year
Agreements
Physicians
1,687
1,673
1,679
1.614
1,520
Average Bonus
$15,252
$15,718
$16,534
$16,982
$15,881
Source: OMB data collection from Federal agencies using PCA. Data from FY 1997 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 number of
one-year contracts dropped by nearly 20% in FY 1996, primarily due to an increase in the use of other
pay authorities by HHS (the largest user of PCA). The number of two-year contracts declined slightly in
FY 1996 as well FY 1997 estimates predict a 9% increase in the number of one-year agreements and a
6% decrease in the number of two-year agreements.
The data on personnel activity show that physicians receiving PCA generally have lower turnover rates
than those who are eligible but not receiving the allowance. In FY 1996, new accessions accounted for
24% of the number of physicians eligible for but not receiving PCA. Of the physicians eligible for but
not receiving PCA, 26% separated from Federal service in FY 1996. The turnover rate among
physicians receiving PCA in FY 1996 was slightly lower than the rate for physicians eligible for but not
receiving PCA. New accessions accounted for 18% of the physicians receiving PCA, with an equal
percentage of physicians receiving PCA separating from Federal service in FY 1996.
The percentage of PCA eligible positions that were unfilled fell from 19% in FY 1994 to 9% in FY
1995, but rose to 12% in FY 1996. While 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, the
fluctuation in unfilled positions continues in FY 1997. Preliminary FY 1997 data predict a decline in
unfilled positions from FY 1996.
Table 3. Data on Accessions, Separations, and Vacancies in Positions Eligible for or Receiving PCA
Federal Physicians Accessions, Separations, and Unfilled Positions
Fiscal Years 1993 to 1997
FY 1993
(Actual)
FY 1994
(Actual)
FY 1995
(Actual)
FY 1996
(Actual)
FY 1997
(Est.)
Number of Physicians Eligible
2.952
2,975
2,916
2,402
2,580
Number of Physicians Receiving PCA
1,896
1,890
2,014
1,841
1,793
% of Eligible Receiving PCA
64%
64%
69%
77%
69%
Accessions
Among Eligible
738
686
562
565
573
% of Eligible
25%
23%
19%
24%
22%
Among PCA
261
211
294
327
228
% of Receiving
14%
11%
15%
18%
13%
Separations
Among Eligible
740
583
674
629
591
% of Eligible
25%
20%
23%
26%
23%
Among PCA
214
163
219
324
292
% of Receiving
11%
9%
11%
18%
16%
Unfilled Positions
Among Eligible
495
560
266
288
256
% of Eligible
17%
19%
9%
12%
10%
Among PCA
294
323
217
209
179
% of Receiving
16%
17%
11%
11%
10%
Source: OMB data collection from Federal agencies using PCA. Data for FY 1997 are estimated. Some agencies did
not provide all of the requested data.
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 these data are
not available, it is not possible to compare the income of Federal physicians with that of private practice
physicians. However, according to a study conducted by the American Medical Association, U.S.
non-Federal physicians earned an average net income (after expenses and before taxes) in 1995 of
$195,000, a 7.2% increase over 1994 income levels. Physicians in general or family practice earned an
average income (after expenses, before taxes) of $124,000.1/ In 1995, the most recent data available,
a total of 681,694 physicians were professionally active in the United States.2/
Summary - Effectiveness of PCA
The FY 1996 data demonstrate that PCA contributes to improved recruitment and retention of Federal
physicians. For example, in FY 1996, the turnover rate among those eligible for but not receiving PCA
was greater than the turnover rate among physicians receiving the allowance. In addition, over the past
several years, three-fourths of all eligible physicians have chosen to enter into service agreements and
receive PCA. However, the data also indicate that there are other factors outside PCA which influence
physicians' decisions to enter Federal service and, therefore, also affect their recruitment and retention.
For example, the higher percentage of accessions among physicians eligible for but not receiving PCA
indicate that physicians choose to enter into Federal service in spite of 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. Based on the
findings in this report, the Administration supports a simple 3-year reauthorization of the PCA authority
to September 30, 2000.
1. American Medical Association Center for Health Policy Research: American Medical News, Jan. 6, 1997.
2. U.S. Department of Health and Human Services: Health: United States 1996, Unpublished 1995 data.
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 OPM and OMB. The following agencies employ
physicians eligible for PCA (listed in descending order of number of physicians receiving PCA in FY
1996):
Department of Health and Human Services Department of Defense
Department of Justice
Department of State
Department of Transportation
NASA
Central Intelligence Agency
Department of Labor
Social Security Administration
Armed Forces Retirement Home
U.S. Agency for International Development
Environmental Protection Agency
Department of Energy
Tennessee Valley Authority
Department of Veterans Affairs
Department of Agriculture
Library of Congress
Department of the Treasury
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 FY 1996, HHS provided PCA to 1,019 out of 1,363 eligible physicians. HHS attributes the decline
in the number of physicians receiving PCA in FY 1996 to the increased use of other pay authorities,
such as physicians special pay under title 38, United States Code. The average allowance was
$16,277, and the average compensation (not including the allowance) of physicians receiving PCA was
$93,223). Among physicians receiving PCA, HHS had 229 accessions, 235 separations, and 149
unfilled positions. The average length of vacancy was six months.
Department of Defense
In FY 1996, the Department of Defense provided PCA to 487 physicians out of 633 eligible. The
average allowance was $13,878 and the average compensation (not including the allowance) of
physicians receiving PCA was $76,578. In the same year the Department had 49 accessions and 75
separations.
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 1996, Justice provided PCA bonuses to 183 physicians out of 198 eligible. The average
allowance was $16,200 and the average compensation (not including the allowance) of physicians
receiving PCA was $92,700. The Bureau had 40 accessions and 46 unfilled positions in FY 1996, but
provided no information on the number of separations.
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 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."
In FY 1996, the Department of State provided PCA to 54 physicians, out of 60 eligible. The average
allowance was $17,500, and the average compensation (not including the allowance) of physicians
receiving PCA was $99,126. In the same year, the Department had five accessions, three separations,
and two 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 1996, the Department of Transportation provided PCA to all of the 35 eligible physicians. The
average allowance was $19,000 and the average compensation of physicians (not including the
allowance) was $86,000.
NASA
NASA is not participating currently in the PCA program. In FY 1996, NASA employed 26 physicians
eligible for PCA and had one unfilled position. NASA did not provide PCA to any physicians.
Central Intelligence Agency (CIA)
Because of specialized security and travel requirements, CIA relies upon PCA to attract and retain
physicians. In FY 1996, CIA provided PCA to 25 out of 26 eligible physicians. The average bonus
was $18,690 and the average non-PCA compensation of the physicians receiving it was $94,171. In
FY 1996, CIA reported no accessions, no separations, and 10 unfilled positions.
Department of Labor (DOL)
The Department of Labor uses PCA in hiring physicians for the Office of Worker's 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.
Past recruitments indicate that the OPM Medical Officer registers do not include candidates with the
experience and knowledge necessary for DOL positions. To obtain qualified candidates, DOL has
contacted 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 refusal. 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 1996, the Department of Labor provided PCA bonuses to six out of 11 eligible DOL physicians.
The average allowance paid was $17,481, and the average compensation (not including the allowance)
was $87,480. In FY 1996, the Department had two separations and one unfilled position.
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 modem 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 1996, SSA provided
PCA to seven out of 10 eligible physicians. The average allowance was $15,000, and the average
compensation (not including the allowance) for physicians receiving PCA was $94,641. SSA had two
separations and no accessions or unfilled positions in FY 1996.
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 FY1996, AFRH had ten physicians eligible for
PCA. Of these, eight physicians received PCA. The USSAH reports that it must offer PCA to attract
specialists in the competitive and expensive Washington area. USNH has one vacancy and AFRH is
not recruiting for the vacancy.
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.
In FY 1996, AID provided allowances to all seven eligible physicians. The average allowance was
$19,710, and the average compensation (not including the allowance) of physicians receiving PCA was
$89,990. In FY 1996, AID had one separation and one unfilled position; the average length of vacancy
for physician positions was five months.
Environmental Protection Agency (EPA)
In FY 1996, the Environmental Protection Agency provided PCA to six out of seven eligible physicians.
The average allowance was $15,583 and the average compensation (not including the allowance) of
physicians receiving PCA was $84,647. EPA reported no accessions, separations, or unfilled positions
in FY 1996.
Department of Energy
The Department of Energy did not provide PCA to any of its four eligible physicians in FY 1996. The
Department had no accessions, separations, or unfilled positions.
Tennessee Valley Authority (TVA)
In FY 1996, the TVA employed four PCA-eligible physicians but did not provide PCA.
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 under the General Schedule. These physicians may be eligible for
PCA. In FY 1996, the Department of Veterans Affairs provided PCA to all three eligible physicians.
The average allowance was $20,000, and the average compensation (not including the allowance) was
$105,177. In FY 1996, the Department had one accession and one separation. A vacancy was unfilled
for six months.
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 1996, USDA paid an allowance of $20,000 to the physician, whose other compensation was
$94,006. USDA had no separations and no unfilled positions in FY 1996.
Library of Congress
In FY 1996, the Library of Congress employed one physician eligible for PCA but did not provide
PCA.
Department of the Treasury
In FY 1996, the Department of the Treasury employed one physician eligible for PCA, but did not
provide PCA.
