Lawmakers blast proposal to overhaul Public Health Service corps

Here is what most people know about the U.S. surgeon general: He (all except two have been male) wears a uniform, and he thinks smoking is really, really bad for you.

Here is what most people don't know about the U.S. surgeon general: He (or she) heads one of the nation's seven uniformed services, the Commissioned Corps of the Public Health Service.

Originally limited to physicians when the nation's first surgeon general, John Maynard Woodworth, founded it in the late 1800s, today the corps comprises approximately 6,000 health professionals, including physicians, dentists, nurses, veterinarians, engineers, pharmacists, bench scientists, dieticians, therapists and health service officers. Members of the corps serve in every agency of the U.S. Public Health Service, including the National Institutes of Health, Centers for Disease Control and Prevention, FDA and Indian Health Service, as well as "on detail" to state and local governments.

For years, about 30 percent of corps members volunteered to be "deployable," or ready to pick up and serve if needed to help with natural or human-made public health emergencies. Members of the corps were dispatched most recently to southern California, to help when wildfires burned through an estimated 750,000 acres over two weeks, causing $2.5 billion in damage and killing more than 20 people.

But in the wake of the Sept. 11, 2001, terrorist attacks and the bioterror threat, HHS Secretary Tommy Thompson wants the corps to be more like the Army or the Navy and less like the group of middle-aged health professionals and bench scientists it has become in recent years. In July, Thompson announced a major overhaul that he said "will forge the Commissioned Corps into a more highly trained, fully deployable force that is prepared to respond to emergency situations."

Among the proposed changes are scholarships to bring more practitioners to medically underserved areas, but also new physical fitness requirements and a system "designed to bring the status of the Commissioned Corps to 100 percent deployability by the end of 2005." Subsequent details also would transfer most supervisory duties for the corps away from the surgeon general to the HHS assistant secretary for health.

While no one has suggested that an overhaul of the corps is a bad idea, the specifics have prompted many complaints, including some from within an administration usually known for keeping its policy differences quiet. FDA Commissioner Mark McClellan, a former White House health adviser, wrote Thompson to complain that if the proposal takes effect, his agency's effectiveness "could be seriously negatively affected" by discouraging expert scientists from joining the corps, and by making the agency reluctant to employ corps members "who might be called away at a moment's notice."

House Government Reform Committee ranking member Henry Waxman, D-Calif., has been less measured in his criticism, calling the proposals "unwise and unfair" and a "bait and switch" for current corps members, some of whom "may suffer from chronic diseases; others may have family obligations that prevent deployment."

In the end, says Waxman, the proposal could make the corps less ready, as the best and brightest opt for the private sector instead. "A more gradual approach would achieve your objective without draining needed scientific expertise from the government or mistreating employees," Waxman wrote Thompson last August.

At a Government Reform Committee hearing on the issue last month, two former surgeons general, C. Everett Koop and Julius Richmond, added their voices to those expressing doubts. Koop said the proposal does not take enough account of the fact that corps members have "day jobs [that] are critically important, whether they are clinicians on a remote Indian reservation or assigned as an epidemiologist or researcher at the CDC."

Richmond was among several who said physical fitness requirements should match a corps member's job requirements. "Had we held to arbitrary standards" when he served as a flight surgeon in World War II, Richmond told the panel, "we would have lost much valuable person-power."

Both of the former vice admirals said the surgeon general should retain leadership of the corps. "It violates any sound principles of management to propose an Office of Commissioned Corps force management to assume functions that the surgeon general has had historically," Richmond testified.

Current Surgeon General Richard Carmona tried to reassure critics the overhaul remains a work-in-progress and insisted the transformation could take place "without disadvantaging any current members of the Corps." But although he said, "No officer will be disadvantaged for promotion by physical fitness standards in the 2004 promotion cycle," he made no promises beyond that.