Working for Uncle Sam
Physicians who work for the federal
government have a variety of job descriptions and enjoy the
chance to shape public policy, conduct research and improve the
health of patients on a much larger scale than in the private
sector. Acknowledging they are lower paid than those in private
practice, these doctors say the positives outweigh the
negatives for them.
The federal government is the
nation’s single largest employer, so it’s no
surprise many of those employees are physicians. Federally
employed physicians work on military bases, Indian
reservations, in federal prisons and veterans’ medical
centers, on the front lines of disaster relief, and behind the
scenes in government programs from Medicare to Head Start. In
2004, some 21,000 physicians worked for the government in
various capacities, not including those employed by the Central Intelligence Agency, the National Security Agency, and the Defense Intelligence
Agency, whose employment
figures are classified for national security reasons. This
figure is projected to increase by 8.2 percent by 2014.
The variety and scope
of work available attracts many physicians to jobs with Uncle
Sam, despite the fact that most physicians in federal
employment earn less than they could in private practice.
Traditionally, federal employees are compensated based on their
GS (general schedule) grade. Pay is based primarily on length
of service. Physicians start at the higher GS levels, but the
system limits how often their pay can be increased.
Even with the current GS
grading system, there’s room for flexibility. Many
physicians receive additional pay through the Physicians’ Comparability Allowance (PCA). PCAs are paid to those categories
of physicians for which an agency is experiencing recruitment
and retention problems. The head of each agency determines
which positions are eligible for PCA. The physician must have
agreed to a particular length of service, and the amount of the
PCA depends on factors such as job duties, length of
employment, and payment for comparable positions both inside
and outside the federal government.
While government jobs
may pay less, these federally employed physicians stress the
benefits—the chance to do work they’re passionate
about, to be involved in cutting edge research, or to have a
hand in developing public policy.
Unique Opportunities spoke
with physicians in six different departments of the federal
government to learn about their experiences and the
opportunities for other physicians
On the front lines of disaster
Maurice Ramirez, MD
Florida Three Disaster Medical Assistance
Team
Tampa, Florida
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Disaster Medical Assistance
Teams like FL-3 operate as part of the Department of Homeland
Security. Each team consists of
35 people who make up one Level One team and two Level Two
teams. A five-person strike team is the
first to respond, whether it’s a natural disaster or a
terrorist attack. The strike team assesses the situation and
establishes a location for operations. A Level Two team follows
to set up the medical tents. When medical personnel arrive,
they go to work right away.
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Maurice Ramirez, MD takes a
break for rehydration with a colleague, Dr.
Friedman, after unloading a Blackhawk helicopter
and treating patients from Beaumont, Texas
following Hurricane Rita.
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Ramirez got involved
with the NDMS after working with a local disaster response team
during hurricanes Charley, Frances, and Ivan. With a background
in emergency medicine and experience with disaster relief, he
was looking for a new challenge. “I started researching
teams and found that Tampa was one of the top-ranked teams in
the US,” he says. “Florida Three is a Level One
team, meaning they’re prepared at any moment to be out
the door within two hours of a call.”
For Ramirez, a
professional speaker as well as a physician, that commitment to
preparedness means traveling with 120 pounds of emergency gear.
“The airlines love to see me coming,” he says.
There are no full-time
paid employees on the disaster teams. NDMS physicians are
essentially reservists. Most have other jobs. Ramirez works for
a hospital emergency room staffing company and travels as a
professional speaker, training businesses in emergency
preparedness and recovery. While deployed, he receives
government G14 pay—the equivalent of $58,000 a year, paid
on an hourly basis, or approximately $30-$35 an hour for
12-hour days while deployed.
“That’s
one of the things my family and I assess on a regular
basis,” he says. “How much can we afford to do? How
many extra ER shifts and speeches do I have to do to make it
up?” Team members are supposed to be employed for only
two weeks at a time, but last year’s string of hurricanes
and other disasters made that time limit effectively
fictitious. Ramirez returned home from his extended stretch of
hurricane duty the first Thursday in November and had only four
days off between then and New Year’s Day.
Despite the
sacrifices, Ramirez finds the work exciting and rewarding.
“I do it because I truly enjoy it,” he says.
He’s challenged not only by the disaster work itself, but
also by the ongoing training required for the job. Disaster
medical training can consist of everything from basic life
support to training on chemical weapons and improvised
explosives.
The field of disaster
medicine is still evolving. “In the last seven hurricanes
I’ve had the opportunity to speak with people and
we’ve learned a tremendous amount about how to do this
better—both on the medical side and the logistical
side,” Ramirez says. “There’s reorganization
occurring even as we speak that will streamline
things.”
Making a difference for underserved
populations
Felicia Collins, MD
Division of Clinical Quality, HRSA
Bureau of Primary Health Care
CDR, Commissioned Corps, US Public Health
Service, Rockville, Maryland
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From the beginning of her medical career,
Felicia Collins knew she wanted to be involved in public
health. After completing a health policy fellowship in Boston,
she joined HRSA in November 1999. As the branch chief and the
chief medical officer of the division of clinical quality, she
works with health centers that serve underserved populations
across the United States. Her office is particularly
responsible for malpractice and clinical risk management
programs for these centers.
The public health centers
Collins works with serve more than 10 million patients. She
finds the knowledge that what she does can have an impact on so
many
people rewarding. “The whole
health-center program is amazing,” she says. “With
relatively little federal funding, what these health centers
are able to do is tremendous. We’ve been able to document
that the health outcomes for patients in this system are much
better than those [patients] who don’t have these clinics
available to them.”
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Felicia Collins, MD, is the
branch chief and the chief medical officer of the
division of clinical quality with HRSA.
© 2006 Chris Usher
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Collins’ office
works closely with physicians in the various clinics funded by
HRSA. While some federal programs channel money through state
or city governments, HRSA provides grants directly to the
clinics, fostering a closer relationship between the department
and the clinics. Having administrators in the bureau with
clinical backgrounds is key to making the program work, she
says.
An ability to work
with other people to develop policy is a must for anyone
wanting to work on the administrative side of public health,
according to Collins. “I think sometimes medical school
and physicians’ training is such that you study a body of
knowledge and become an expert,” she says. “Public
health and health policy is not that way. A lot of what happens
is consensus building. Physicians, business people,
administrators, and others all bring something to the
table.”
In addition to working
well with others, patience is definitely a virtue in public
policy work. “If there’s someone who needs
immediate gratification, working in the government can be
challenging,” Collins says. “There are multiple
processes involved. It takes longer for things to happen, but
from my perspective, when you get something to happen, the
impact is so great it’s worth it.”
Impacting public health
Marshalyn Yeargin-Allsopp, MD
National Center on Birth Defects and
Developmental Disabilities,
Atlanta, Georgia
Atlanta, Georgia
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A relocation to Atlanta in 1981 led to
Marshalyn Yeargin-Allsopp’s move from the private to the
public sector. As a developmental pediatrician, she was looking
for a clinical position and learned the CDC wanted to expand
work in the field of developmental disabilities.
Yeargin-Allsopp began her CDC career in the Epidemic Intelligence Service. The EIS is a two-year program that recruits
physicians who are interested in public health.
As both a public
health researcher and a clinician, Yeargin-Allsopp designs
studies to look at risk factors and the rates of disabilities
among children and develops strategies for prevention.
She’s also involved in research, writing papers, giving
presentations, and representing the CDC in various venues.
“I love my
job,” she says. “I do feel like I have the best of
both worlds, a marriage between the clinical work and the
public health work.”
Yeargin-Allsopp has a
particular focus on autism. She was involved in an effort to
document autism in children in the United States, work that
revealed the prevalence of the disorder is 10 times higher than
had been reported earlier. Now she and her team are studying
causes and treatments for autism.
The move from a
private medical practice to the public sector is not for
everyone, Yeargin-Allsopp admits. For one thing, the ratio of
paperwork and other office duties to actual patient contact is
higher than in private practice. “We do a lot of writing
and speaking,” she says. “If you want to do this,
you need to refine your written and oral communication skills.
You’re going to spend a lot more time writing and editing
documents and talking to people than you ever would think when
you’re studying anatomy and physiology.”
For Yeargin-Allsopp,
however, the CDC has been a good fit. “It’s
important for me to feel that I’m making a
contribution,” she says. “As a physician, we know
we’re helpful. We see a patient, prescribe a treatment,
and often the patient gets better. That’s fulfilling. In
public health, the results aren’t seen immediately.
They’re often delayed. Your patient is not an individual,
but really a whole community. You don’t have that
immediate gratification you might have as a clinician. But you
have the ability to impact a larger number of people in public
health.”
