United States Government Accountability Office

GAO Report to Congressional Committees

MILITARY 

PERSONNEL 

Military Departments 

Need to Ensure That 

Full Costs of 

Converting Military 

Health Care Positions 

to Civilian Positions 

Are Reported to 

Congress 

May 2006 

 

GAO-06-642 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

May 2006

MILITARY PERSONNEL

Military Departments Need to Ensure That 

Full Costs of Converting Military Health 

Care Positions to Civilian Positions Are 

Reported to Congress 

Highlights of GAO-06-642, a report to 

congressional committees 

Based on studies showing that 

many military members are 

performing tasks that are not 

considered military essential, the

Air Force, Army, and Navy have

plans to convert certain numbers of

military health care positions to 

civilian positions. Questions have

surfaced regarding the potential 

effects of these conversions on the 

Defense Health Program. The 

National Defense Authorization Act 

for Fiscal Year 2006 prohibits the 

military departments from 

performing any further conversions

until the secretary of each 

department certifies to Congress 

that the conversions will not 

increase costs or decrease quality

or access to care. The act also 

requires GAO to study the military 

departments’ conversions and their 

potential effects. Specifically, GAO

examined (1) the military

departments’ plans for and actions

to date in converting military

health care positions to civilian 

positions and the departments’ 

experiences in filling the converted 

positions with civilians and (2) the

potential effects of converting 

military health care positions to 

civilian positions on the Defense 

Health Program. 

What GAO Recommends

GAO is making recommendations 

for the Department of Defense

(DOD) to account for the full costs 

of military health care positions 

converted or planned for

conversion. In reviewing a draft of

this report, DOD agreed with

GAO’s recommendations.

The Air Force, Army, and Navy have converted or have plans to convert 

several thousand military health care positions to civilian positions and have 

made progress in hiring civilian replacement personnel. From fiscal years 

2005 through 2007, the Air Force, Army, and Navy collectively have 

converted or plan to convert a total of 5,507 military health care positions to 

civilian positions. Of the 5,507 military health care positions, the 

departments plan to convert 152 physician positions, 349 nurse positions, 

and 208 dental positions to civilian positions. In fiscal year 2006, there were

a total of 10,352 military physicians, 9,138 nurses, and 3,020 dentists in the 

Air Force, Army, and Navy. The Navy is the most significantly affected of the 

three military departments, having converted or planning to convert a total 

of 2,676 military health care positions, representing 49 percent of the total 

5,507 positions converted or planned for conversion. While the departments 

have been recruiting for about 4 to 7 months to hire civilian replacements for 

converted positions, to date, they have not experienced significant 

difficulties filling the civilian positions. 

The military departments do not expect the conversions to affect medical

readiness, quality of care, recruitment and retention of military health care 

personnel, or decrease beneficiaries’ access to care. However, it is unknown 

whether the conversions will increase or decrease costs to DOD. At present, 

the military departments may not prepare their congressional certifications 

using cost data prepared by DOD’s Office of Program Analysis and 

Evaluation, which is identifying the full costs for military health care

positions. Instead, the military departments may use cost data that do not 

contain all the costs, like training, necessary to support a military medical 

position. Without accounting for the full costs in their methodologies, the 

military departments will not be able to make a true comparison of the total 

costs required to support military positions versus civilian positions. 

Moreover, Congress will be unable to judge the extent to which the 

departments’ certifications are based on actual and anticipated 

compensation costs for civilian hires unless they include such delineations 

in their certifications. 

Military to Civilian Health Care Position Conversions, Fiscal Years 2005–07 

Actual

conversions 

Planned 

conversions 

All conversions,

FY 2005-07 

Military 

department FY 2005 FY 2006 FY 2007 Total Percent

Air Force 0 401 813 1,214 22

Army 0 1,029 588 1,617 29

Navy 1,772 215 689 2,676 49

Total 1,772 1,645 2,090 5,507

Percent of total

conversions 32 30 38 100

Source: GAO analysis of Air Force, Army, and Navy data. 

www.gao.gov/cgi-bin/getrpt?GAO-06-642.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Derek Stewart 

at (202) 512-5559 or stewartd@gao.gov. 
Contents 

Letter 1

Results in Brief 3

Background 5

Military Departments Converting Military Health Care Positions to 

Civilian Positions and Making Progress Filling Civilian Positions 7 

Conversions Not Expected to Alter Medical Readiness, Quality of 

Care, Recruitment and Retention, or Access to Care, but Effects 

on Cost to DOD Unknown 13 

Conclusions 21

Recommendations for Executive Action 21 

Agency Comments and Our Evaluation 21 

Appendix I Scope and Methodology 24 

Appendix II Conversion of Navy Military Physician Positions by 

Specialty 27 

Appendix III Conversion of Military Health Care Positions to 

Civilian Positions by Geographic Region 28 

Appendix IV Navy’s Experience in Recruiting Civilians for 

Converted Military Health Care Positions, Fiscal 

Year 2005 30 

Appendix V Comments from the Department of Defense 31 

Appendix VI GAO Contact and Staff Acknowledgments 34 

Tables 

Table 1: Defense Health Program Appropriation, Fiscal Years 

2005-07 5

Page i GAO-06-642 Military Personnel
Table 2: Number of Military Health Care Positions Converted or 

Planned for Conversion to Civilian Positions, Fiscal Years 

2005-07 7

Table 3: Military Health Care Positions Converted or Planned for 

Conversion to Civilian Positions by Type of Position and 

Grade, Fiscal Years 2005-07 9 

Table 4: Military Health Care Positions Converted or Planned for 

Conversion to Civilian Positions by Type of Position and 

Grade, Fiscal Years 2005-07 (Detailed) 10 

Table 5: Combined Air Force, Army, and Navy Military Medical 

Readiness Requirements Compared to Combined Military 

Departments’ Medical and Dental Personnel End-strength, 

Fiscal Year 2004 14 

Table 6: Navy Military Physician Positions Converted by Specialty, 

Fiscal Years 2005 and 2006 27 

Table 7: Military Installations, by Military Department, with the 

Largest Cumulative Numbers of Military Health Care 

Positions Converted or Planned for Conversion to Civilian 

Positions, Fiscal Years 2005-07 28 

Table 8: Navy Experience in Recruiting Federal Civilian Health

Care Personnel to Fill Converted Military Positions in 

Fiscal Year 2005 by Type of Position, as of January 31, 

2006 30 

Abbreviations 

DHP Defense Health Program 

DOD Department of Defense 

GS General Schedule 

MHS Military Health System 

MQA Medical Quality Assurance 

PA&E Office of Program Analysis and Evaluation 

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Page ii GAO-06-642 Military Personnel
United States Government Accountability Office

Washington, DC 20548 

May 1, 2006

The Honorable John Warner 

Chairman 

The Honorable Carl Levin 

Ranking Minority Member 

Committee on Armed Services 

United States Senate 

The Honorable Duncan L. Hunter 

Chairman 

The Honorable Ike Skelton 

Ranking Minority Member 

Committee on Armed Services 

House of Representatives 

Since September 11, 2001, the high pace of operations has created 

significant stress on the military’s operating forces. In late 2003, the 

Department of Defense (DOD) reported that recent studies had found 

thousands of military personnel were being used to accomplish work tasks 

that were not military essential. DOD found that civilian or private sector 

contract employees could perform these tasks in a more efficient and costeffective manner than military personnel. As a result, DOD directed the 

military departments to identify and convert certain targeted numbers of 

military positions to federal civilian or contract positions.1

 Along with 

other functional areas, the military departments identified military health 

care2

 positions that could be converted. Questions have surfaced, 

however, regarding the potential effects of these actual and planned 

conversions on the Defense Health Program (DHP), especially given that 

military health care personnel provide care to the families of 

servicemembers and to retirees in addition to active duty members. 

 1

 The military departments consist of the Air Force, Army, and Navy. The Navy is 

responsible for providing medical and dental support to the Marine Corps. Also, hereafter,

we will refer to federal civilian or contract positions as “civilian positions.” 

2

 For the purpose of this report, military health care personnel includes medical, dental, 

and other personnel associated with the delivery of health care in the Defense Health 

Program. 

Page 1 GAO-06-642 Military Personnel
The National Defense Authorization Act for Fiscal Year 20063

 prohibits the 

military departments from performing any further conversions of military 

medical or dental positions to civilian positions until the secretary of each 

department submits, not before June 1, 2006, to the Committees on Armed 

Services of the Senate and the House of Representatives a certification 

that the conversions will not increase costs or decrease quality of care or 

access to care. The act also requires us to study the military departments’ 

plans and progress, and the potential effects on the DHP of converting 

military health care positions to civilian positions. For this report, we 

examined (1) the military departments’ plans for and actions to date in 

converting military health care positions to civilian positions and the 

departments’ experiences in filling these converted positions with civilians 

and (2) the potential effects of converting military health care positions to 

civilian positions on the DHP. 

To examine the military departments’ completed and planned conversions 

of military health care positions, we obtained the number, type, and 

location of positions converted or planned for conversion from military 

health care positions to civilian positions during fiscal years 2005 through 

2007 from the offices of the surgeon general of the Air Force, Army, and 

Navy. To examine the military departments’ experience in filling the 

converted positions with federal civilian or contract employees, we 

requested that the offices of the surgeons general for the Air Force, Army, 

and Navy provide information on the extent to which the converted 

positions were filled, the time required to fill converted positions, and 

reasons for delays in filling the positions. To identify the potential effects 

of converting military health care positions on the DHP, we obtained and 

examined the offices of the surgeons general’s assessments regarding how

the conversions would affect medical readiness,4 cost of the DHP, quality 

of care, beneficiaries’ access to care, and recruitment and retention of 

military medical and dental personnel. In addition, we conducted focused 

analyses at the Naval Medical Center, Portsmouth. We chose this facility 

because it had the largest number of health care conversions of any Navy

facility for fiscal year 2005 and represented the location with the largest 

number of conversions planned during fiscal year 2005 through fiscal year

2007. At the Naval Medical Center, Portsmouth, we examined data on 

 3

 Pub. L. No. 109-163, § 744 (2006). 

4

 For the purposes of this report, medical readiness personnel requirements include those 

military health care personnel required to meet the demands of the operational scenarios in

the national military strategy.

Page 2 GAO-06-642 Military Personnel
waiting times for appointments in selected departments before and after 

conversion of military physician positions. We determined that the data

used in this report were sufficiently reliable for our purposes. We also 

discussed the potential effects on the DHP of converting military health 

care positions to civilian positions with officials from the TRICARE 

Management Activity in the Office of the Assistant Secretary of Defense 

for Health Affairs; from the offices of the surgeon general for the Air 

Force, Army, and Navy; from the Office of Program Analysis and 

Evaluation (PA&E); and from the Naval Medical Center, Portsmouth. For 

more detailed information on our scope and methodology, see appendix I.

We performed our work from November 2005 through April 2006 in 

accordance with generally accepted government auditing standards. 

The Air Force, Army, and Navy have converted or have plans to convert 

military health care positions to civilian positions and have made progress 

in hiring civilian replacement personnel. From fiscal years 2005 through 

2007, the Air Force, Army, and Navy collectively have converted or plan to

convert a total of 5,507 military health care positions to civilian positions, 

representing 6.1 percent of the military departments’ DHP military 

personnel. Specifically, the military departments converted 1,772 positions

(32 percent of the total planned conversions) in fiscal year 20055

 and 1,645 

positions (30 percent of the total) in fiscal year 2006, and plan to convert 

2,090 positions (38 percent of the total) in fiscal year 2007. The Navy is the 

most significantly affected of the three military departments. The Navy has 

converted or plans to convert 2,676 military health care positions, 

representing 49 percent of the total positions converted or planned for 

conversion. In contrast, the Air Force has converted or plans to convert 

1,214 positions, or 22 percent of the total conversions and the Army has 

converted or plans to convert 1,617, or 29 percent of the total conversions. 

Of the total military health care positions converted or planned for 

conversion, the majority are enlisted positions, while about 20 percent are 

military officer positions. By the end of fiscal year 2007, the departments 

plan to have converted 152 physician positions, 349 nurse positions, and 

208 dental positions to civilian positions. By comparison, in fiscal year 

2006, there were a total of 10,352 military physicians, 9,138 nurses, and 

3,020 dentists in the Air Force, Army, and Navy. The Navy, however, is the 

Results in Brief 

 5

 The Navy was the only military department to convert any military health care positions 

to civilian positions in fiscal year 2005. Also, the Navy made a staffing decision not to

convert military health care positions to civilian positions on a one-for-one basis.

Page 3 GAO-06-642 Military Personnel
only department that plans to convert any physician positions. Regarding

the hiring of replacements, the Navy has the most experience hiring 

civilians for the converted positions, but that experience is limited to 7 

months. While the departments have been recruiting for a short time to 

hire civilian replacements for converted positions, they have each made 

varying degrees of progress and to date, have not experienced significant

difficulties filling the civilian positions. In 7 months time, the Navy filled 

two-thirds of the positions it converted in fiscal year 2005, and the Air 

Force and Army have filled 37 percent and 30 percent of their fiscal year 

2006 positions, respectively, within 4 months’ time. 

While the military departments do not expect the conversions to affect 

medical readiness, quality of care, recruitment and retention of military 

health care personnel, or to decrease beneficiaries’ access to care, it is 

unknown whether the conversions will increase or decrease costs to DOD. 

Based on our examination of the military departments’ application of the 

DOD medical readiness sizing model for determining which military health 

care positions are required for medical readiness, and our understanding 

of how the military departments determined which health care positions 

should be considered for conversion, it is unlikely that the conversions 

will affect medical readiness. Only military positions in excess of those 

required to meet the demands of the operational scenarios included in the 

national military strategy were considered candidates for conversion. 

Similarly, because each military department has maintained the same 

credentialing and privileging processes for civilian medical and dental care 

providers, quality of care is not expected to be affected by the 

conversions. In addition, given that many factors could affect a health care 

professional’s decision to join or leave military service, it is difficult to 

isolate what potential effect the military-to-civilian conversions will have 

on recruitment and retention of military medical and dental personnel. 

However, it is unknown whether the military to civilian conversions will 

increase or decrease costs to DOD because (1) it is uncertain what actual

compensation levels will be required to successfully hire replacement 

civilian personnel and (2) the methodologies each department is 

considering using in its certifications to Congress may not include the full 

costs for military personnel. Currently, the military departments may not 

prepare their certifications using cost data prepared by DOD’s PA&E, 

which is currently identifying total costs for military health care positions. 

Without accounting for the full costs in their analyses, the military 

departments will not be able to make a true comparison of military 

positions to the costs to support civilian positions. Also, Congress will be 

unable to judge the extent to which the military departments’ certifications 

are based on actual and anticipated compensation costs for completed and 

Page 4 GAO-06-642 Military Personnel
future civilian hires unless the military departments include such 

delineations in their certifications to Congress. 

We are making recommendations to ensure that the military departments 

account for the full costs of military health care positions converted or 

planned for conversion when they report to Congress. In written 

comments on a draft of this report, DOD generally concurred with our 

recommendations. DOD’s comments are reprinted in appendix V. 

The Military Health System (MHS) provides health support for the full 

range of military operations and for military servicemembers and their 

families, military retirees, retiree family members, and survivors. The 

Defense Health Program (DHP) appropriation supports worldwide 

medical and dental services to eligible beneficiaries, veterinary services, 

medical command headquarters, graduate medical education and other 

training of medical personnel, and occupational and industrial health care. 

The DHP appropriation supports operations of 70 inpatient facilities, 409 

medical clinics, 417 dental clinics and 259 veterinary clinics, and funds 

multiple TRICARE6

 contracts that augment health care delivery. Table 1 

shows total DHP appropriations and budget estimates for fiscal years 2005 

through 2007. 

Background 

Table 1: Defense Health Program Appropriation, Fiscal Years 2005-07

Dollars in millions 

FY 2005 FY 2006 FY 2007

Operation and maintenancea$17,497.1 $19,386.9 $20,249.2

Procurement 368.3 403.9 396.4

Research, development, test and evaluation 523.1 536.9 130.6

Total $18,388.5 $20,327.7 $20,776.2

Source: Department of Defense and President’s Budget Position for Fiscal Year 2007. 

a

The military departments programmed $ 35.8 million in fiscal year 2005, $ 215.7 million in fiscal year 

2006, and $135.4 million in fiscal year 2007 for the conversion of military health care positions to 

civilian positions.

 6

 DOD provides health care through TRICARE, a regionally structured program that uses 

civilian contractors to maintain health care provider networks that complement health care 

provided at military treatment facilities. 

Page 5 GAO-06-642 Military Personnel
In fiscal year 2005, the MHS employed approximately 42,400 federal 

civilian employee full-time equivalents whose costs were funded by the 

DHP. The MHS also employed about 90,000 military medical, dental, and 

support personnel. The cost of these military personnel who support DHPfunded activities is funded by each military department’s military 

personnel appropriation. 

In December 2003, DOD directed the military departments to convert 

certain targeted numbers of military positions, including some health care 

positions, to federal civilian or contract positions based on evaluations 

that showed many military personnel were being used to accomplish work

tasks that were not military essential and could be performed more cost 

efficiently by civilians.7

 According to DOD officials, the conversion process 

began in late 2003/early 2004 with the creation of a task force, chaired by

the Director of PA&E including members from offices of the Assistant 

Secretary of Defense for Health Affairs and the surgeons general for the 

Air Force, Army, and Navy, to identify military medical and dental 

positions that could be converted to federal civilian or contract positions. 

The task force examined 121 occupational medical and dental specialties 

for potential conversion. It applied a DOD medical readiness personnel 

sizing model to identify the baseline medical readiness personnel 

requirements for each military department, taking into consideration only 

those positions that members believed would not be required for medical 

readiness, would not degrade clinical capabilities, would not reduce 

access to medical or dental care to beneficiaries, or would not increase

costs to DOD. 

As the military departments began to implement the conversions, each 

military department reassessed the availability and affordability of civilian 

replacement personnel in the geographical areas where conversions were 

planned. Adjustments were then made to the military departments’ plans 

to reflect local medical commanders’ assessments. According to officials 

with the offices of the surgeons general for the Air Force and Army, 

conversions of military health care positions in their military departments 

are planned to be replaced on a one-for-one basis with civilian or 

personnel. However, according to a Navy official, the Navy decided to link 

a reassessment of appropriate medical and dental staffing levels in its 

medical centers to the conversion process. This reassessment, among 

other things, reviewed the number and type of staffing required to meet 

 7

 Program Budget Decision 712, December 24, 2003. 

Page 6 GAO-06-642 Military Personnel
clinical productivity goals and quality standards. Applying the results of 

the staffing reassessments resulted in the Navy concluding that there was 

no need to hire civilian personnel replacements for 345 of the 1,772 

positions converted for fiscal year 2005. 

The Air Force, Army, and Navy have each begun implementing plans to 

convert non-military essential health care positions to civilian positions 

and have made progress in hiring civilians to fill the converted positions. 

During fiscal years 2005 through 2007, the military departments have 

converted or plan to convert about 5,500 military health care positions to 

civilian positions, including certain numbers of physician, nurse, and 

dental positions. While the departments have been recruiting for a short 

time to hire civilian replacements for converted positions, they have each 

made varying degrees of progress and to date, have not experienced 

significant difficulties filling the civilian positions. 

The Air Force, Army, and Navy have each made plans and begun 

converting military health care positions to civilian positions. During fiscal 

years 2005 through 2007, the departments have converted or plan to 

convert a total of 5,507 military health care positions to civilian positions, 

representing 6.1 percent of the total DHP military personnel. Specifically,

the departments converted 1,772 positions (32 percent of the total planned 

conversions) in fiscal year 2005, 1,645 positions (30 percent) in fiscal year 

2006, and plan to convert 2,090 positions (38 percent) in fiscal year 2007. 

Table 2 summarizes the number of planned/converted positions by military 

department. 

Military Departments 

Converting Military 

Health Care Positions 

to Civilian Positions 

and Making Progress 

Filling Civilian 

Positions 

Air Force, Army, and Navy 

Have Converted or Plan to 

Convert Military Health 

Care Positions to Civilian 

Positions 

Table 2: Number of Military Health Care Positions Converted or Planned for 

Conversion to Civilian Positions, Fiscal Years 2005-07 

Actual conversions

Planned 

conversions

All conversions, 

FY 2005-07

Military 

department FY 2005 FY 2006 FY 2007 Total Percent

Air Force 0 401 813 1,214 22

Army 0 1,029 588 1,617 29

Navy 1,772 215 689 2,676 49

Total 1,772 1,645 2,090 5,507

Percent of total 

conversions

32 30 38 100

Source: GAO analysis Air Force, Army, and Navy data. 

Page 7 GAO-06-642 Military Personnel
Conversion by military department: The Navy is the most significantly 

affected of the three military departments by the military to civilian 

conversions. The Navy has converted or plans to convert 2,676 military 

health care positions, representing 49 percent of the total positions 

converted or planned for conversion in DOD. In addition, as table 2 shows, 

the Navy was the only department that converted positions in fiscal year 

2005, converting a total of 1,772 positions—32 percent of the total number 

of planned/converted positions. By contrast, the Air Force has converted 

or plans to convert 1,214 positions, or 22 percent of the total conversions 

and the Army has converted or plans to convert 1,617, or 29 percent of the 

total conversions. 

Conversion by type of position and grade: While each of the 

departments plans to convert both enlisted and officer health care 

positions to civilian positions, the majority of positions planned for 

conversion are enlisted positions (80 percent), while military officer 

positions account for about 20 percent of the conversions. Military health

care positions consist of (1) medical—including not only health care 

providers who directly interact with patients, but also a variety of support 

positions whose functions directly relate to medical care, such as 

laboratory, radiology and dietary technicians; (2) dental—including 

dentists and dental technicians and assistants; and (3) other—including a 

variety of positions that are part the DHP but which do not directly affect 

the provision of medical or dental care to patients, such as administrators 

and public affairs officers. Table 3 shows the breakdown of types of health

care positions converted or planned for conversion by each military 

department. 

Page 8 GAO-06-642 Military Personnel
Table 3: Military Health Care Positions Converted or Planned for Conversion to

Civilian Positions by Type of Position and Grade, Fiscal Years 2005-07 

Type of position Air Force Army Navy Total Percent

Medical 

 Officers 228 128 412 768

 Enlisted 589 794 1,622 3,005

 Subtotal 817 922 2,034 3,773 69

Dental 

 Officers 0 32 176 208

 Enlisted 132 59 388 579

 Subtotal 132 91 564 787 14

Other DHP 

 Officers 15 44 67 126

 Enlisted 250 560 11 821

 Subtotal 265 604 78 947 17

Total 1,214 1,617 2,676 5,507 100

Source: GAO analysis of Air Force, Army, and Navy data. 

As table 3 shows, the majority of the health care positions that have been

or are scheduled for conversion fall into the medical category (69 

percent). Dental positions account for 14 percent of the total conversions, 

while other positions represent 17 percent of the total conversions. 

Of all health care positions, the type of position most affected by the 

conversions for fiscal years 2005 through 2007 is the position categorized 

by the Navy as enlisted corpsman, by the Army as an enlisted medic, and 

by the Air Force as enlisted aerospace medical services personnel.8

 Within 

the medical category, the three positions with high rates of conversion are 

physician, nurse, and dentist. By the end of fiscal year 2007, the 

departments plan to have converted 152 physician positions, 349 nurse 

positions, and 208 dental positions to civilian positions. In fiscal year 2006,

there were a total of 10,352 military physicians, 9,138 nurses, and 3,020 

 8

 Navy corpsmen serve in various hospital departments such as radiology, laboratory, and 

clinics and also perform administrative duties such as patient records management and 

appointment scheduling. Army medics provide emergency and routine outpatient and

inpatient medical care and also perform administrative duties. Aerospace medical services

personnel serve in various capacities such as licensed practical nurses, occupational health 

specialists, and emergency medical technicians and perform other administrative 

functions. 

Page 9 GAO-06-642 Military Personnel
dentists in the Air Force, Army, and Navy. The Navy, however, is the only

department that plans to convert any physician positions—neither the 

Army nor the Air Force plans to convert any military physician positions 

to civilian positions. Appendix II shows the military physician positions by 

specialty converted by the Navy in fiscal year 2005 and fiscal year 2006. 

Table 4 provides a detailed breakdown of military health care positions 

converted or planned for conversion to civilian positions by type of 

position and grade. 

Table 4: Military Health Care Positions Converted or Planned for Conversion to

Civilian Positions by Type of Position and Grade, Fiscal Years 2005-07 (Detailed) 

Type of position/grade Air Force Army Navy Total Percent

Officers

Physicians 0 0 152 152 3

Physician assistants 3 0 39 42 0.8

Nursesa177 75 97 349 6

Dentists 0 32 176 208 4

Pharmacists 6 13 29 48 0.9

Optometrists 5 11 3 19 0.3

Psychologists 2 8 1 11 0.2

Social workers 11 6 0 17 0.3

Other medical positionsb24 21 91 136 2

Other DHP positionsc15 38 67 120 2

Total officersd243 204 655 1102 20

Enlisted

Corpsmen, medics, aerospace medical 

services 

47 482 1620 2149 39

Dental assistants/technicians 132 59 388 579 11

Other Medical Positions 542 312 2 856 16

Other DHP positions 250 560 11 821 15

Total enlisted 971 1413 2021 4405 80

Total 1214 1617 2676 5507 100

Source: GAO analysis of Air Force, Army, and Navy data. 

a

Nurses includes eight nurse practitioners scheduled for conversion by the Air Force, five in fiscal 

year 2006 and three in fiscal year 2007. b

Other military medical officer positions include dieticians, physical therapists, speech pathologists,

radiation health/radiation specialists, microbiologists, and biochemists. c

Other DHP military officer positions include administrative positions. d

Includes Army warrant officers. 

Page 10 GAO-06-642 Military Personnel
Appendix III provides information regarding the military departments’ 

military to civilian conversions by geographical region. 

Military Departments 

Making Progress Hiring 

Civilian Replacements 

Each of the military departments has made varying degrees of progress in 

hiring civilian personnel to fill military health care positions that have 

been converted to civilian positions. According to military department 

officials, the Air Force ceased hiring actions to fill its fiscal year 2006 

converted positions in January 2006 and the Army in February 2006 after 

enactment of the National Defense Authorization Act for Fiscal Year 2006.

However, their experiences to date suggest they have not encountered 

significant difficulties hiring civilian personnel to fill converted positions. 

Of the three departments, the Navy has the most experience hiring civilian

replacements, filling two-thirds of the positions it converted in fiscal year 

2005. As table 2 shows, the Navy converted a total of 1,772 military health

care positions to civilian positions in fiscal year 2005. According to a Navy 

official, while these conversions took place on October 1, 2004, the first 

day of fiscal year 2005, the Navy did not begin recruiting civilians to fill the 

converted positions until July 2005 to allow for (1) Navy military treatment 

facilities to assess their staffing needs, (2) military personnel to vacate the 

converted positions, and (3) consultations with human resource offices to 

develop federal civilian job announcements. Also, the Navy decided not to 

fill all of the military health care positions it converted. After 

reassessments of medical and dental staffing levels at its facilities, the 

Navy decided to fill only 1,361, or 77 percent, of the 1,772 converted 

military positions. Over a 7-month period for these 1,361 positions, the 

Navy had successfully recruited 907, or 67 percent, of the civilians needed,

as of January 31, 2006. Appendix IV provides more detailed information 

about the Navy’s experience in hiring civilian personnel by type of 

position. Before enactment of the National Defense Authorization Act for 

Fiscal Year 2006, Navy officials indicated that they had planned to begin 

hiring civilian personnel in April 2006 to fill the 215 military health care 

positions converted at the beginning of fiscal year 2006.9

 9

 According to DOD officials, the military departments remove military positions from

authorized military endstrength for conversion to civilian positions on October 1, the first 

day of the fiscal year. Hiring of civilian or contract personnel to fill converted positions is a 

separate action which may occur later. In the case of the Navy, funding for hiring civilian 

replacement personnel becomes available at the midpoint of the fiscal year in the first year

of conversion. 

Page 11 GAO-06-642 Military Personnel
A Navy official told us that there have been no significant difficulties in 

filling such a large number of federal civilian positions within a short 

period of time. However, public and private employers report a limited 

supply of certain types of medical and dental personnel both on a national 

level and in certain geographical areas. In 2005, the Bureau of Labor 

Statistics reported that nurses were considered difficult to hire and retain

by non-military employers and forecast that employers will continue to 

compete for nursing services. In addition, in December 2005, the Health 

Resources and Services Administration, an agency of the Department of 

Health and Human Services, reported that about 20 percent of the U.S. 

population lives in a primary medical care health professional shortage 

area.10 According to a Navy official, based on this information, the Navy is 

recruiting on a national level to hire four types of personnel—physicians, 

dentists, pharmacists, and laboratory officers—at its various facilities. For

its other types of medical and dental positions, the Navy is seeking to hire

civilian personnel by targeting local markets. Also, the Navy is using 

various special pay provisions to allow it to compete with other 

employers, such as Department of Veterans Affairs’ medical centers in 

selected geographical areas. 

Because the Air Force and Army only began converting military health 

care positions to civilian positions in fiscal year 2006, their experiences 

hiring civilians to fill converted positions are more limited than the Navy’s 

experience. However, as of January 2006, the Air Force had successfully 

recruited 149, or 37 percent, of the 401 positions converted within 4 

months. The Army recruited 305, or 30 percent, of the 1,029 military health

care positions converted within 4 months. Air Force and Army officials 

told us that they have not experienced significant difficulties in hiring 

civilian replacement personnel. 

 10 This designation is based on the number of physicians in a geographic area, per unit of 

population. A separate designation is based on the number of dentists. 

Page 12 GAO-06-642 Military Personnel
The military departments do not expect conversion of military health care 

positions to civilian positions to have any effect on medical readiness, the 

quality of care, recruitment and retention of military health care 

personnel, and beneficiaries’ access to care. However, it is unknown what 

effect the conversions will have on the cost to DOD. 

Based on our examination of the military departments’ application of the 

DOD medical readiness sizing model for determining which military health 

care positions are required for medical readiness, and our understanding 

of how the military departments determined which health care positions 

should be considered for conversion, it is unlikely that the conversions 

will affect medical readiness. Incorporating scenarios that reflected 

operational plans, each military department applied DOD’s medical 

readiness sizing model to identify the number of military health care 

personnel required for medical readiness. In determining which specific 

military health care positions would be converted, each department, in 

consultation with military health care facilities, then assessed the impact

of conversions on medical readiness. Senior medical officials told us that 

the military departments’ plans for converting military health care 

positions to civilian positions are not expected to have any effect on 

medical readiness because only military positions in excess of those 

needed for medical readiness were candidates for conversion. In defining

medical readiness personnel requirements, the military departments 

included those military health care personnel required to meet the 

demands of the operational scenarios included in the National Military 

Strategy. Moreover, while not generalizable to all facilities and all military 

departments, our examination of military health care positions converted 

at Naval Medical Center, Portsmouth showed that the conversions did not 

affect medical readiness.

Conversions Not 

Expected to Alter 

Medical Readiness, 

Quality of Care, 

Recruitment and 

Retention, or Access 

to Care, but Effects 

on Cost to DOD 

Unknown 

Medical Readiness 

According to DOD officials, in 2004, the Air Force, Army, and Navy, in 

identifying which military health care positions were candidates for 

conversion, initially determined the military positions that would be 

required for medical readiness, incorporating scenarios that reflected

Page 13 GAO-06-642 Military Personnel
operational plans. The operational plans incorporated joint medical 

requirements, and the military departments then used these requirements 

to define medical requirements to respond to anticipated casualties, 

including those wounded in action and those with disease and nonbattle 

injuries. In defining medical readiness requirements for the military-tocivilian conversion process, each military department used the national

military strategy that was current at that time. Using a DOD-approved 

medical readiness personnel sizing model,11 the military departments 

identified the number of military medical and dental personnel that was 

required for medical readiness. Table 5 shows the number of positions the 

departments determined to be required for medical readiness compared to 

the military medical and dental endstrength for the Air Force, Army, and 

Navy for fiscal year 2004.

Table 5: Combined Air Force, Army, and Navy Military Medical Readiness 

Requirements Compared to Combined Military Departments’ Medical and Dental 

Personnel End-strength, Fiscal Year 2004 

Number of positions

required for medical 

readiness 

Military medical/dental 

endstrength, FY 2004

Non-medical

readiness endstrength, FY 2004

Medical corps 10,557 12,067 1,510

Nursing corps 9,652 10,412 760

Dental corps 2,735 3,532 797

Other medical

service 

10,587 11,709 1,122

Total officers 33,531 37,720 4,189

Enlisted medical 65,162 74,388 9,226

Enlisted dental 4,706 6,816 2,110

Total enlisted 69,868 81,204 11,336

Total 103,399 118,924 15,525

Source: Office of Assistant Secretary of Defense for Health Affairs. 

Only those military positions in excess of those positions required for 

medical readiness were considered for possible conversion to federal 

civilian or contract positions. 

 11 We did not assess the validity of the DOD medical readiness personnel sizing model or

the reasonableness of the assumptions and data used in applying the model.

Page 14 GAO-06-642 Military Personnel
According to a DOD official, in 2005, the military departments again used 

the DOD-approved medical readiness personnel sizing model to identify 

their medical readiness requirements for the purpose of setting endstrength requirements for the fiscal years 2006-2011 time frame. Medical 

officials for the Air Force, Army, and Navy told us that they again used the 

national military strategy, which was current at that time, in applying the 

medical readiness sizing model. Officials from the Air Force, Army, and 

Navy told us the model produced results showing that the services’ 

medical/dental personnel endstrength exceeded medical readiness 

personnel requirements. 

Our review of military positions converted at Naval Medical Center, 

Portsmouth showed no apparent effect on medical readiness 

requirements. To test the assertion that none of the positions converted at

the Naval Medical Center, Portsmouth, had a mobilization/readiness 

mission, we examined the 352 military health care positions that were 

converted to federal civilian positions on October 1, 2004, for fiscal year 

2005. Of the 352 military positions examined, we found 349 positions did 

not have mobilization/readiness missions. Although three of the 352 

military positions had mobilization/readiness missions, a Navy medical 

official explained that they transferred the mobilization requirement for 

the converted military positions to other positions that were not scheduled 

for conversion to avoid any effect on medical readiness. We verified that 

the mobilization missions for the converted military positions were 

transferred to other military positions not scheduled for conversion. 

Quality of Care Because the military services have maintained the same processes and 

requirements for delivery of health care by civilian employees and 

considering the results of our limited testing of the credentialing and 

privileging process at Naval Medical Center, Portsmouth, the military 

departments’ plans for military-to-civilian conversions are not expected to 

adversely affect the quality of care. Officials in the offices of the surgeon 

general for the Air Force, Army, and Navy told us that converting military 

health care positions to civilian positions will not result in decreased 

quality of care because each department has maintained the same 

Page 15 GAO-06-642 Military Personnel
credentialing and privileging requirements12 for civilian personnel. Also, in

developing civilian position descriptions for converted military health care 

positions, officials told us that they give close attention to appropriately 

identifying the required education, training, and professional qualifications 

of applicants. Officials also stated that before civilian applicants are hired, 

their compliance with the educational and other minimum qualification 

requirements for the civilian positions will be verified. Our examination of 

the credentialing and privileging documentation for selected civilian 

personnel hired to fill converted military health care positions at the Naval 

Medical Center, Portsmouth, found that required queries of national health

care databases were performed for each civilian employee and the results 

of the queries revealed no adverse information about the civilian 

employees hired. 

In May 2002, the Assistant Secretary of Defense for Health Affairs defined 

quality in health care in responding to the Healthcare Quality Initiative 

Review Panel’s recommendation to promulgate a definition of quality 

concerning healthcare and related services within the Military Health 

System to orient current and future measurement initiatives. Quality in 

health care was defined as “the degree to which health care services for 

individuals and population increase the likelihood of desired health 

outcomes and are consistent with current professional knowledge.”13 In 

conjunction with the promulgation of this definition, the Assistant 

Secretary of Defense for Health Affairs required that the quality of health

care be assessed by performance measures addressing three specific 

questions: (1) Is the foundation for the provision of high-quality care in

place and is this foundation robust? (2) How well does our health care 

system perform with respect to measurable processes and outcomes of 

care and other comparable data? and (3) How is our health care delivery 

 12 Credentialing of health care personnel refers to the process of inspecting and verifying 

the credentials of health care practitioners. The credentials process is conducted before 

the granting of clinical privileges and is repeated at the time of reappointment and renewal 

of privileges. Clinical privileging refers to the granting of permission and responsibility of a 

health care provider to provide specified health care within the scope of a provider’s

license, certification, or registration. Clinical privileges define the scope and limits of 

practice for individual providers and are based on the capability of the health care facility, 

licensure, training, experience, health status, judgment, and peer and department head

recommendations. 

13 Department of Defense, Office of the Assistant Secretary of Defense for Health Affairs, 

Military Health System Definition of Quality in Health Care, HA-Policy: 02-016, May 9, 

2002. 

Page 16 GAO-06-642 Military Personnel
system and quality of health care provided viewed by our beneficiaries, 

military leadership, and Congress? 

Officials in the offices of the surgeon general for the Air Force, Army, and

Navy told us that they have many processes and performance measures 

within the MHS to ensure the delivery of quality health care. Each military 

department already employs many civilian employees who work in 

military treatment facilities. Officials told us that these civilian employees 

are subject to the same quality of care assessments and processes as 

military medical and dental personnel. The civilian personnel who will be 

hired to replace converted military positions will also be subject to the 

same quality of care processes and performance assessments. 

To test the credentialing and privileging processes for the civilian 

replacement personnel hired at the Naval Medical Center, Portsmouth, we

examined the credentialing and privileging files for 27 civilian employees: 

5 physicians, 8 dentists, 3 pharmacists, and 11 other types of personnel 

hired to replace converted military positions in fiscal year 2005. All five 

civilian physicians hired were board certified in their respective specialty. 

As part of our examination, we also reviewed the files for documentation 

that officials had queried health care practitioner databases, as required by

DOD.14 We found documentation in the credentialing and privileging files 

from the National Practitioner Data Bank15 and the Healthcare Integrity 

and Protection Data Bank16 showing that both data banks were queried, as

required, for all of these civilian employees. The query results revealed no

adverse information about the civilian employees hired. 

 14 Department of Defense Directive 6025.13, Medical Quality Assurance (MQA) in the 

Military Health System (MHS), signed by the Deputy Secretary of Defense, May 4, 2004. 

15 The National Practitioner Data Bank was established under the Health Care Quality 

Improvement Act of 1986, Pub. L. No. 99-660 (1986), as an information clearinghouse to 

improve the quality of health care by collecting and releasing information related to the

professional competence and conduct of physicians, dentists, and other health care 

practitioners. 

16 The Healthcare Integrity and Protection Data Bank was established by the Health 

Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191 (1996), as a means 

to prevent fraud and abuse in health insurance and health care delivery and to improve the

quality of care.

Page 17 GAO-06-642 Military Personnel
Given the multitude of factors that may influence an individual health care 

professional’s decision to join or leave military service, it is difficult to 

isolate the potential effect of converting military health care positions to 

civilian positions on the recruitment and retention of military health care 

personnel. Officials in the offices of the surgeons general for the Air Force, 

Army, and Navy told us that the military-to-civilian conversions will not 

have any impact on recruiting and retention of military health care 

personnel. For example, Navy officials commented that while the Navy is 

experiencing difficulties in recruiting and retaining certain types of health

care personnel, factors other than planned military-to-civilian conversions, 

such as military pay levels and the Global War on Terrorism, are 

responsible. Army officials commented that they recognize the importance 

of viable medical career fields and will perform career progression 

analyses to ensure that the medical career fields are viable. Air Force 

officials commented that conversions will be accomplished through 

normal attrition, and no individuals will be forced to retire or separate 

from the military as a result of the conversions. 

Officials in the offices of the surgeon general for the Air Force and Army 

stated that converting military health care positions to civilian positions 

will not result in any degradation in the availability of medical or dental 

care to servicemembers, their families, or retirees because converted 

military medical and dental positions are being replaced on a one-to-one 

basis. So for every converted military health care position, there will be a 

civilian personnel replacement. Moreover, neither the Air Force nor the 

Army plans to convert any physician positions during fiscal years 2006 and

2007. While the Air Force and Army’s decision not to convert any military 

physician positions will probably decrease the likelihood for significant 

reductions in the availability of medical care, it is important to note that 

delays in filling the civilian positions after the military positions have been 

removed may result in decreased military medical capacity. Air Force and

Army medical officials pointed out that they have the option of purchasing 

medical or dental care from the managed care network of health care 

providers, if necessary, to avoid any decreases in servicemembers’ or 

beneficiaries’ access to care. 

Recruitment and Retention 

of Military Health Care 

Personnel 

Access to Care 

Officials in the office of the surgeon general of the Navy told us that they 

do not expect any decreases in servicemembers’ or beneficiaries’ access to

care attributable to the conversions even though, in many instances, 

military health care positions were not replaced on a one-for-one basis. 

With the new staffing levels, Naval Medical Center, Portsmouth, officials

believe that the mix of current staffing for departments is more efficient 

Page 18 GAO-06-642 Military Personnel
and will not result in longer waiting times for appointments. Also, Naval 

Medical Center, Portsmouth, officials pointed out that the purchased care 

system (managed care network of health care providers) is available if 

capacity within the medical center becomes temporarily limited. 

At the Naval Medical Center, Portsmouth, we examined data on waiting 

times for appointments before and after the conversion in two 

departments and a family practice clinic that had military physician 

positions converted for fiscal year 2005 and found that for the most part, 

waiting times did not increase after the conversions. On October 1, 2004,

military physician positions were converted in the departments of internal 

medicine and physical therapy and in the family practice clinic at the 

Naval Medical Center, Portsmouth. Naval Medical Center, Portsmouth, 

officials told us that it is difficult to attribute changes in appointment 

waiting times to the military-to-civilian conversions because several 

factors, such as the deployment of military physicians or the arrival or 

departure of ships, may affect the departments’ capacity or demand for 

appointments. Data that we obtained from the two departments and a 

family practice clinic at the Naval Medical Center, Portsmouth, showed for 

the most part that waiting times were within standards for appointment 

waiting times for varying types of appointments. 

Cost of Conversions to 

DOD 

It is unknown whether the conversion of military health care positions to 

civilian positions will ultimately increase or decrease costs for DOD 

because: 

• it is uncertain what actual compensation levels will be required to 

successfully hire most civilian replacement personnel and 

• the programming rates the departments are considering using in their 

certifications to Congress about the cost of the conversions to DOD do not 

include the full compensation costs for military personnel. 

While officials in the offices of the surgeons general for the Air Force, 

Army, and Navy believe that the military-to-civilian conversions will not 

increase costs, we believe it is uncertain how much it will cost to hire 

civilian replacement personnel for recent and planned conversions of 

military health care positions and whether this cost will exceed the cost 

for the military positions. While the military departments have made 

progress in hiring civilian personnel within a short time, many civilian 

personnel remain to be hired. As of January 31, 2006, the Navy had 

recruited 67 percent of the personnel it plans to hire for the conversions 

made in fiscal year 2005, and the Air Force and Army had recruited 37 

Page 19 GAO-06-642 Military Personnel
percent and 30 percent, respectively, of the positions they converted in 

fiscal year 2006. However, according to DOD officials, as of March 6, 2006,

the Air Force, Army, and Navy had not compared the actual costs to hire 

these federal civilian employees with what it had cost them to employ 

military personnel in these positions. 

The methodologies the military departments may use to certify conversion 

costs in their reports to Congress may understate savings associated with 

the elimination of military medical and dental positions, according to 

PA&E officials. While the Air Force, Army, and Navy had not finalized the

methodologies they plan to use in the certification process, at the time of 

our review, representatives from the offices of the surgeons general for the 

Air Force, Army, and Navy discussed the possibility of using military 

department-specific programming rates. These rates are calculated by 

dividing the military personnel budgets by the number of military 

personnel currently employed by the Air Force, Army, and Navy. However, 

according PA&E officials, this calculation omits several significant costs 

(such as training, recruitment, educational assistance, and health benefit

costs) incurred by military medical personnel which may lead to 

understated cost projections for the converted military positions. 

PA&E officials told us that at this time they lack complete information on 

all of the costs that are associated with compensating military medical and 

dental personnel. Officials told us that PA&E is completing a project 

designed to determine true military medical and dental personnel costs, 

but the project is not expected to be completed until summer 2006, which 

is after the June 1, 2006 date when the military departments may submit 

certifications to the House and Senate Committees on Armed Services that

their planned conversions of military medical or dental positions will not 

increase costs. In the meantime, PA&E has completed preliminary 

estimates, which officials believe are far more complete in estimating the 

cost of military medical and dental positions than the programming rates 

that may be used by the Air Force, Army, and Navy. These preliminary 

estimates show that the programming rates considerably understate 

military medical and dental personnel costs when compared to the PA&E 

estimates. Currently, the military departments are not required to 

coordinate the development of their cost comparisons for the 

congressional certifications with PA&E. By not coordinating their cost 

analyses efforts with PA&E to ensure that they are considering the full 

costs of the military medical and dental positions they have converted or 

plan to convert to civilian positions, the Air Force, Army, and Navy will be

unable to determine the true cost implications for defense health care. 

Page 20 GAO-06-642 Military Personnel
While the Air Force, Army, and Navy are already well under way in 

converting about 5,500 military health care positions to civilian positions, 

they are not currently in the position to know how the conversions will 

affect the cost to DOD. Because none of the military departments has 

plans to use cost data prepared by the DOD’s PA&E, they risk using 

methodologies to certify program costs that omit several significant 

factors, such as training, recruitment, and educational assistance. Without 

ensuring that they are accounting for the full costs—both direct and 

indirect—of converting the military health care positions to civilian 

positions, the military departments will be unable to provide Congress 

with accurate comparative costs for their conversions. Further, Congress 

will be unable to judge the extent to which the military departments’ 

certifications are based on anticipated compensation costs for completed 

and future civilian hires unless the military departments include such 

delineations in their congressional certifications. 

To ensure that the military departments account for the full costs of 

military health care positions converted or planned for conversion when 

they report to Congress, we recommend that the Secretary of Defense 

direct the Secretaries of the Air Force, Army, and Navy to take the 

following two actions: 

• Coordinate the development of their congressional certifications for 

military health care conversions with the Office of Program Analysis and 

Evaluation in order to consider the full cost for military personnel and for 

federal civilian or contract replacement personnel in assessing whether 

anticipated costs to hire civilian replacement personnel will increase costs 

to DOD for defense health care. 

• Address in their congressional certifications for military health care 

conversions the extent to which total projected costs for hiring federal 

civilian or contract personnel include actual compensation costs for 

completed hires and anticipated compensation costs for future hires. 

DOD provided written comments on a draft of this report and generally 

concurred with our recommendations. 

In commenting on our recommendation that the secretaries of the military 

departments coordinate with DOD’s PA&E in developing their 

congressional cost certifications, DOD noted that PA&E’s effort to identify 

the total cost for military health care positions is not yet complete and that 

it is unlikely that these data will be available in a final format for use by 

Conclusions 

Recommendations for 

Executive Action 

Agency Comments 

and Our Evaluation 

Page 21 GAO-06-642 Military Personnel
June 1, 2006, the date DOD stated the military departments are required to 

provide their cost certifications to Congress. We note, however, that the 

National Defense Authorization Act for Fiscal Year 2006 does not require 

the secretary of each military department to submit such certifications by 

June 1, 2006. Instead, the act requires the department secretaries to submit 

their certifications not before June 1, 2006. DOD also commented that the 

PA&E data add several personnel cost items that are not included in the 

military departments’ programming rates, and that these additional costs 

will generate a higher average cost per military member than that reflected 

by the programming rates. While it is indeed possible that using PA&E 

data—which include costs such as training, recruitment, educational 

assistance, and health benefits—will provide higher average costs for 

military members than the military departments’ programming rates that 

do not include these additional costs, we believe it is important that the 

military departments provide Congress with the most accurate 

comparative costs of converting the military health care positions to 

civilian positions. 

In commenting on our recommendation that the military departments 

certifications address the extent to which total projected costs for hiring

civilian personnel include actual compensation costs for completed hires 

and anticipated compensation costs for future hires, DOD stated that our 

recommendation appears to be unnecessary because in order to make a 

certification that the conversions will not increase costs, each secretary 

will review actual civilian employee and contract employee costs for 

conversions already completed, as well as estimated costs for pending 

conversions. It is important to note that while the military departments 

have made progress in hiring civilian replacement personnel, 74 percent of

the civilian replacement personnel for military health care positions 

converted and planned for conversions during fiscal years 2005 through 

2007 had not been hired as of January 31, 2006. So, the military 

departments’ certifications on the total projected costs of the conversions 

are likely to be based more on anticipated rather than actual 

compensation costs. Consequently, we believe that it is important for 

Congress to understand the extent to which the military departments’ 

certifications are based on actual compensation costs for completed hires 

versus projected compensation costs for future hires. 

DOD’s comments are reprinted in appendix V. DOD also provided 

technical comments, which we have incorporated in the final report where 

appropriate.

Page 22 GAO-06-642 Military Personnel
We are sending copies of this report to the Secretary of Defense and other

interested parties. We will provide copies of this report to others upon 

request. In addition, the report is available at no charge on the GAO Web 

site at http://www.gao.gov. 

If you or your staffs have any questions about this report, please contact 

me at (202) 512-5559 or stewartd@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made key contributions to this report 

are listed in appendix VI.

Derek B. Stewart 

Director, Defense Capabilities and Management 

Page 23 GAO-06-642 Military Personnel
Appendix I: Scope and Methodology Appendix I: Scope and Methodology 

To meet our objectives, we reviewed pertinent documents, reports, and 

other information, as available, that related to the conversion of military 

health care positions to federal civilian or contract positions. We also 

interviewed cognizant officials in the TRICARE Management Activity 

within the Office of the Assistant Secretary of Defense for Health Affairs, 

the offices of the surgeons general of the Air Force, Army, and Navy, the 

Office of Program Analysis and Evaluation, and the office of the 

Undersecretary of Defense for Personnel and Readiness. We also 

performed additional work at the Naval Medical Center in Portsmouth, 

Virginia. 

To examine the extent to which the military departments have developed 

and implemented plans to convert military health care positions to civilian 

positions, we obtained data on Defense Health Program positions that 

have been converted since October 1, 2004, and those planned for 

conversion through fiscal year 2007 from the offices of the surgeon general 

for the Air Force, Army, and Navy. For each position converted or planned 

for conversion, we requested that the offices of the surgeons general to

provide the geographic location, type of position, and the grade (either 

officer or enlisted position). We analyzed the data obtained from each 

military department to identify the characteristics of the positions 

converted for fiscal year 2005 and fiscal year 2006 and planned for 

conversion in fiscal year 2007. We also obtained information regarding the

process used by the military departments in selecting the number and 

types of positions converted and planned for conversion from discussions 

with officials within the offices of the surgeons general and reviews of 

documentation. 

To identify the experiences of the military departments in filling the 

converted military positions with civilian personnel, we requested that the 

military departments identify for each converted position the following 

information as of January 31, 2006: 

• Location 

• Former military position title 

• Date converted 

• Billet occupied on date of conversion 

• Current civilian position title 

• Programmed as General Schedule (GS) or contract position

• Date recruitment initiated 

• Date civilian or contract employee reported for duty 

• Whether civilian position was filled as of January 31, 2006 

• Whether the civilian position was filled by a GS or contract employee 

Page 24 GAO-06-642 Military Personnel
Appendix I: Scope and Methodology 

• If civilian position was not filled, status of recruitment efforts 

• If civilian position was not being recruited, reasons why 

We analyzed the data obtained from the military departments to identify 

the characteristics of their experiences in filling the federal civilian or 

contract positions by type of position and by geographical area and to 

identify reasons for difficulties in filling positions, if any. We also reviewed

information from the Bureau of Labor Statistics and the Health Resources 

and Services Administration to identify the types of health professional 

positions that are considered to be difficult to fill. 

We took steps to ensure the reliability of the data we used in our review. 

We provided an Excel spreadsheet and specification of data elements to 

the Army, Air Force, and Navy. The spreadsheet had 16 defined variables 

in which we requested data for military health care positions converted to 

a civilian position since October 1, 2004. Several of the data elements were 

restricted to drop-down menu choices to minimize error and clearly 

convey the type of response we were seeking. The military departments 

returned the Excel spreadsheet to us in electronic format. To assess the 

reliability of these data, we reviewed the data for obvious inconsistency 

errors and completeness and compared the total number of positions 

converted with official numbers we were given in interviews with officials. 

In addition, we reviewed any related accompanying documentation and 

worked closely with agency officials to identify any data problems. When 

we found discrepancies (such as nonpopulated fields or data 

inconsistencies), we brought them to our points of contact’s attention and 

worked with them to correct the discrepancies before conducting our 

analyses. In addition, we sent an electronic questionnaire with questions 

regarding the data to our points of contact and followed up on any issues 

we felt pertinent regarding the reliability of the data. Based on these 

efforts, we determined that the data were sufficiently reliable for the 

purposes of our report. 

In regard to the potential effects of conversions, we focused on potential 

impacts on medical readiness, cost, quality of care, access to care, and 

recruitment and retention of military medical and dental personnel. For 

each of these potential effects, we requested that the military departments 

provide their assessments and the basis for their views. To obtain detailed

information regarding the effects of conversions, we selected the Naval 

Medical Center, Portsmouth, for focused analyses because it had the 

largest number of health care conversions of any Navy facility for fiscal 

year 2005 and represented the location with the largest number of 

conversions planned from fiscal year 2005 through fiscal year 2007. 

Page 25 GAO-06-642 Military Personnel
Appendix I: Scope and Methodology 

Regarding potential effects of the conversions on medical readiness, we 

obtained and examined information regarding the process used by the 

military departments in determining the medical readiness personnel 

requirements. We did not assess the validity of the DOD medical readiness 

personnel sizing model or the reasonableness of the assumptions and data 

used in applying the model. Also, we examined whether each of the 352 

positions converted for fiscal year 2005 at the Naval Medical Center, 

Portsmouth, had a mobilization/readiness mission and, if so, whether the 

mission was transferred to another position that was not converted. 

Regarding the potential effects of the conversions on the quality of care,

we obtained information on the processes that the military departments 

will use to ensure quality of care delivery by civilian replacement 

personnel. We examined the credentialing and privileging documentation

and assessed whether queries were made, as required, to the National 

Practitioner Data Bank and the Healthcare Integrity and Protection Data 

Bank as part of the credentialing and privileging process in hiring the 

civilian replacement employees at Naval Medical Center, Portsmouth. 

Regarding access to care, we obtained and examined military department 

representatives’ assessments of the potential effect of conversions on 

servicemember and beneficiary access to care. We also requested and 

analyzed data from the Naval Medical Center, Portsmouth, on the extent to

which TRICARE access to care standards were being met in those 

departments where military physician positions were converted. 

Regarding the potential effect of the conversions on the cost of defense 

health care to DOD, we discussed with officials in the offices of the 

surgeons general, the methodology that they planned to use in certifying to 

Congress that planned conversions would not increase costs. We also 

discussed the extent to which military department-specific programming

rates include the full costs for military personnel with representatives 

from the Office of Program Analysis and Evaluation and from the Office of

the Undersecretary of Defense for Personnel and Readiness.

We performed our work from November 2005 through April 2006 in 

accordance with generally accepted government auditing standards. 

Page 26 GAO-06-642 Military Personnel
Appendix II: Conversion of Navy Military Appendix II: Conversion of Navy Military Physician Positions by Specialty 

Physician Positions by Specialty 

The Navy is the only military department that has converted any military 

physician positions since October 1, 2004—converting 148 physicians 

during fiscal year 2005 and 4 physicians during fiscal year 2006. Of the 152 

military physician positions converted by the Navy, 41, or 27 percent, were

family practice physicians; 37, or 24 percent, were pediatric physicians; 21, 

or 14 percent, were general medical officers; and 17, or 11 percent, were 

internal medicine physicians, as shown in table 6. There are no military 

physicians scheduled for conversions in fiscal year 2007. 

Table 6: Navy Military Physician Positions Converted by Specialty, Fiscal Years 

2005 and 2006

Type of Specialty Fiscal Year 2005 Fiscal Year 2006 Total

Family practice 41 0 41

General surgeon 1 0 1

General medical officera21 0 21

Internal medicineb17 0 17

Neurology 2 0 2

Nuclear medicine 2 0 2

Obstetrics/gynecology 6 0 6

Ophthalmology 2 0 2

Pathology 9 0 9

Pediatricsc34 3 37

Physical medicine 3 0 3

Psychiatry 8 1 9

Radiology 1 0 1

Urology 1 0 1

Total 148 4 152

Source: GAO analysis of Navy data. 

a

A general medical officer has completed medical school, including a 1-year internship but has not

completed specialty residency training. 

b

Internal medicine conversions include internal medicine physicians with specialties in cardiology, 

gastroenterology, and pulmonary disease as well as general internal medicine physicians. 

c

Pediatrics conversions include pediatric physicians with specialties in adolescence, cardiology, 

genetics and sexual abuse in addition to general pediatric physicians. 

Page 27 GAO-06-642 Military Personnel
Appendix III: Conversion of Military Health 

Care Positions to Civilian Positions by Appendix III: Conversion of Military Health Geographic Region 

Care Positions to Civilian Positions by 

Geographic Region 

The military departments’ plans for converting military health care 

positions to civilian positions are widely dispersed among many locations 

within each military department. The Navy’s actual and planned 

conversions of military health care positions to federal civilian positions 

are occurring at 39 different locations, both in the United States and 

overseas. Of these locations, the majority—34, or 87 percent—have fewer 

than 200 positions scheduled for conversion. Table 7 shows the locations 

of the largest numbers of military health care positions to civilian 

positions. 

Table 7: Military Installations, by Military Department, with the Largest Cumulative 

Numbers of Military Health Care Positions Converted or Planned for Conversion to 

Civilian Positions, Fiscal Years 2005-07 

Location FY 2005 FY 2006 FY 2007 Total

Army 

William Beaumont Army Medical Center, Fort 

Sam Houston, San Antonio, Texas 

0 170 51 221

Walter Reed Army Medical Center, 

Washington, D.C. 

0 125 56 181

Madigan Army Medical Center, Fort Lewis, 

Washington 

0 13 98 111

Tripler Army Medical Center, Hawaii 0 54 27 81

Brooke Army Medical Center, Fort Bliss, Texas 0 48 26 74

Navy 

Naval Medical Center, Portsmouth, Virginia 347 34 111 492

Naval Medical Center, San Diego, California 208 52 78 338

Naval Hospital, Great Lakes, Illinois 224 40 65 329

National Naval Medical Center, Bethesda, 

Maryland 

 158 33 72 263

Naval Health Care-New England, Newport, 

Rhode Island 

 120 7 83 210

Air Force 

Lackland Air Force Base, San Antonio, Texas 0 46 61 107

Keesler Air Force Base, Biloxi, Mississippi 0 33 68 101

Travis Air Force Base, Fairfield, California 0 27 38 65

Wright Patterson Air Force Base, Dayton, Ohio 0 17 39 56

Langley Air Force Base, Hampton, Virginia 0 19 34 53

Source: GAO analysis Air Force, Army, and Navy data. 

The military-to-civilian conversions of Air Force health care positions are 

occurring at 62 locations in the United States. The majority of these 

Page 28 GAO-06-642 Military Personnel
Appendix III: Conversion of Military Health 

Care Positions to Civilian Positions by

Geographic Region 

locations, 57, or 92 percent, are scheduled for fewer than 50 conversions 

for fiscal years 2006 and 2007. At 5 Air Force locations the number of 

conversions planned exceeds 50, including Lackland Air Force Base, 

Keesler Air Force Base, Travis Air Force Base, Wright-Patterson Air Force 

Base and Langley Air Force Base. Lackland and Keesler are the most 

significantly affected with 107 and 101 conversions, respectively. 

The military-to-civilian conversions of Army military health care positions 

are occurring at 124 locations in the United States and overseas. Of these 

124 locations, 59 are Army installations, 20 are for Army personnel at other 

service installations, and 45 are at military entrance processing 

commands. The majority of these locations, 116, or 94 percent, are 

scheduled for fewer than 50 conversions for fiscal years 2006 and 2007. At 

8 locations, the number of Army conversions planned exceeds 50 including

Fort Sam Houston, Walter Reed Army Medical Center, Fort Lewis, Tripler 

Army Medical Center, Fort Bliss, Fort Bragg, Fort Rucker, and Fort 

Gordon. Fort Sam Houston and Walter Reed Army Medical Center are the 

most significantly affected with 221 and 181 conversions, respectively. 

Page 29 GAO-06-642 Military Personnel
Appendix IV: Navy’s Experience in Recruiting

Civilians for Converted Military Health Care Appendix IV Positions, Fiscal Year 2005 : Navy’s Experience in Recruiting 

Civilians for Converted Military Health Care 

Positions, Fiscal Year 2005 

As of March 16, 2006, the Navy had hired exclusively federal civilians as 

replacement personnel under the General Schedule but had also approved 

the hiring of 14 physicians as contract employees because of concerns that 

higher compensation levels than are available under the General Schedule

system would be necessary to hire these physicians. The Navy’s 

experience in successfully recruiting federal civilian health care personnel 

to replace military health care positions converted in fiscal year 2005 

varied by type of position, as shown in table 8. 

Table 8: Navy Experience in Recruiting Federal Civilian Health Care Personnel to 

Fill Converted Military Positions in Fiscal Year 2005 by Type of Position, as of

January 31, 2006 

Type of Position 

Number who are on 

board/accepted job offers 

Number 

being 

recruited

Percentage

of converted

positions

Physicians 49 77 64

Physician assistants 13 25 52

Nurses 92 122 75

Dentists 60 89 67

Pharmacists 27 31 87

Optometrists 1 1 100

Psychologists 0 1 0

Social workers 5 6 83

Dental 

assistants/hygienists 

126 199 63

Other medical or DHP 

positions 

534 810 66

 Total 907 1,361 67

Source: GAO analysis of office of the surgeon general of the Navy data. 

Page 30 GAO-06-642 Military Personnel
Appendix V: Comments from the Department Appendix V of Defense : Comments from the Department 

of Defense 

Page 31 GAO-06-642 Military Personnel
Appendix V: Comments from the Department 

of Defense 

Page 32 GAO-06-642 Military Personnel
Appendix V: Comments from the Department 

of Defense 

Page 33 GAO-06-642 Military Personnel
Appendix VI: 

A

GAO Contact and Staff 

cknowledgments 

Page 34 GAO-06-642

Appendix VI: GAO Contact and Staff 

Acknowledgments 

Derek B. Stewart (202) 512-5559 or stewartd@gao.gov

In addition to the individual named above, Sandra Bell, Assistant Director; 

Steve Fox; Benjamin Bolitzer; Alissa Czyz; Dawn Godfrey; Jennifer Jebo; 

Lynn Johnson; William Mathers; Julia Matta; and Terry Richardson made 

key contributions to this report. 

Military Personnel

GAO Contact 

Acknowledgments 

(350754) 
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