****OMB Bulletin No. 97-05****
****OMB Home****

April 24, 1997

BULLETIN NO. 97-05

TO THE HEADS OF EXECUTIVE DEPARTMENTS AND ESTABLISHMENTS

SUBJECT: Physicians Comparability Allowance Data Reporting Requirements

1. **Purpose.** This Bulletin, which includes Attachments A through C, provides detailed instructions on agency data reporting requirements regarding operation of the Physicians Comparability Allowance (PCA) program. The Bulletin is issued pursuant to the 1996 edition of OMB Circular A-11, section 13.2(b)(12).

Collection of the data by OMB is required to monitor government-wide PCA usage, physician employment, and physician compensation. The data will be used to evaluate the effect of the PCA on Federal physician recruitment and retention and to issue the 1997 Presidential Report on the Physicians' Comparability Allowance in accordance with the Federal Physicians Comparability Allowance Act of 1978 Extension (P.L. 103-114).
2. **Background.** On October 26, 1993, the President signed P.L. 103-114, reauthorizing the Federal Physicians Comparability Allowance until September 30, 1997. This Act extends authority to pay annual bonuses for Federal physicians serving in areas or specialties with documented recruitment and retention problems.
Office of Personnel Management (OPM) regulations implementing PCA require OMB approval of agency plans to pay bonuses. OPM regulations implementing the PCA are published in 5 CFR 595.
OMB is collecting data on PCA program operation and Federal physician recruitment and retention to ensure consistent government-wide implementation and to evaluate the effectiveness of the PCA program.
3. **Due Date.** Agencies must submit the requested data by May 19, 1997.
4. **Termination Date.** This Bulletin will terminate as soon as the requested data have been submitted.
**Franklin D. Raines***Director*
Attachments

**ATTACHMENT A**
**Agencies with currently approved PCA Plans**
Department of Defense Department of Energy Department of Health and Human Services Department of Labor Department of State Department of Transportation Social Security Administration United States Soldiers' and Airmen's Home
**Agencies that have employed or now employ physicians eligible for PCA**
Agency for International Development Central Intelligence Agency Department of Agriculture Department of the Interior Department of Justice Department of Treasury Department of Veterans Affairs Environmental Protection Agency Library of Congress National Aeronautics and Space Administration Tennessee Valley Authority
****NOTE:** Agencies not listed that employ physicians eligible for PCA are also covered by this Bulletin.
**ATTACHMENT B**Physicians Comparability Allowance (PCA) Report and Worksheets
**Authority**.

5 U.S.C. 5948 authorizes payment of physicians comparability allowance to eligible individuals paid as physicians under the following pay systems: General Schedule; administratively determined pay for certain specially qualified scientific or professional personnel; Tennessee Valley Authority Act; Foreign Service Act; CIA Act; section 121 of title 2 of the Canal Zone Code; or section 2 of the Act of May 29, 1959, relating to the National Security Agency.
P.L. 100-140, the Federal Physicians Comparability Allowance Amendments of 1987, amended 5 U.S.C. 5948 to provide a maximum PCA of $14,000 per year for physicians with less than 24 months' Federal service, and $20,000 per year for physicians with 24 or more months' Federal service. P.L. 100-140 also allows physician service in the Department of Veterans Affairs and the Public Health Service Commissioned Corps to be creditable towards 24 months Federal civilian service when calculating maximum PCA allowance eligibility. P.L. 103-114 reauthorized PCA until September 30, 1997.
Executive Order No. 12109 delegates authority granted the President under 5 U.S.C. 5948 to the Directors of the Office of Personnel Management and the Office of Management and Budget.
5 CFR 595 sets additional requirements for agency implementation of 5 U.S.C. 5948, including agency reporting requirements.
OMB Circular A-11, 13.2(b)(12), requires agencies to reflect approved plans to pay bonuses in annual budget estimates in accordance with P.L. 100-140 and P.L. 103-114.
Coverage
. This Bulletin covers all agencies that employ physicians eligible for PCA. This includes both agencies with currently approved PCA plans that are eligible to pay PCA bonuses, whether or not they actually do pay the bonuses, and agencies without approved plans that employ physicians eligible for PCA. Attachment A lists those agencies that currently have an approved PCA plan, as well as agencies that do not currently have an approved plan but are known to have employed physicians eligible for PCA. Agencies not listed that employ physicians eligible for PCA are still covered by this Bulletin.
Submission Requirements
. (1) Each agency should review and update the 1996 PCA reporting worksheet submitted by that agency. (Copies of the 1996 data have been given to the appropriate OMB staff. Agencies should contact their OMB examiners if they need a copy of the 1996 data.)
Please verify that all FY 1993 - FY 1996 figures in the worksheet are correct and add a new column providing FY 1997 estimates. See below for instructions on how to calculate figures.
(2) Review the attached copies of the 1996 Presidential Report on the PCA (Attachment C). Verify and update the text for your agency that appears in the section entitled "Summary of Agency PCA Reports," pp. 5 to 10.
Submit the revisions to the PCA Report and PCA worksheet to the OMB examiner responsible for that agency.
Information Contact:
 Inquiries should be addressed to Marc Garufi, telephone (202) 395-4926.
Instructions for Preparing Worksheet
**General guidance**

The data requested should be supplied for all Federal physicians 
eligible
 for PCA, and as a subset, all Federal physicians actually 
receiving
 PCA. Eligibility for PCA is defined in 5 U.S.C. 5948 and 5 CFR 595.
Data for the budget year should be the estimates included in budget formulation where applicable (e.g., average PCA per physician, average compensation, etc.) or the agency's best estimate (e.g., number of accessions anticipated). Agency estimates may simply be the average of the previous fiscal years. All dollars should be on an obligational basis, and all employment numbers should be on a full-time equivalent (FTE) basis unless otherwise noted.
Several sections of the worksheet request data by physician category. Some agencies may not employ physicians in all categories, but complete data should be provided for those physician categories applicable to the agency.
**Definitions-General**
Government Physician
. 5 U.S.C. 5948(g)(1) defines Government physician as any individual paid as a physician under the following pay systems: General Schedule; administratively determined pay for certain specially qualified scientific or professional personnel; Tennessee Valley Authority Act; Foreign Service Act; CIA Act; section 121 of title 2 of the Canal Zone Code; or section 2 of the Act of May 29, 1959, relating to the National Security Agency.
Creditable Federal Service
. For purposes of PCA bonus calculations under 5 U.S.C. 5948, as amended by P.L. 100-140, creditable federal service includes service as a Government physician in any of the personnel systems established under authorities listed immediately above, as well as service as a physician in the Department of Veterans Affairs and the Public Health Service Commissioned Corps.
**Definitions-Physician Categories**
**Category I-Clinical Positions**: Positions primarily involving the practice of medicine as a direct service to patients, including the performance of diagnostic, preventive, or therapeutic services to patients in hospitals, clinics, public health programs, diagnostic centers, and similar settings.
**Category II-Research Positions**: Physician positions primarily involving research and investigative assignments.

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

**Category IV-Disability Evaluation and Administration of Health and Medical Programs**:
**Subcategory IV A**: Physician positions primarily involving disability evaluation.
**Subcategory IV B**: Physician positions primarily involving the administration of health and medical programs, including but not limited to a chief of professional services, senior medical officer, or physician program director position.
**Description Worksheets to Be Submitted to OMB**

(1) 
Total Number Employed
: The total number of agency physicians 
eligible
 for PCA (includes all eligible physicians, whether or not they actually received PCA bonuses) should be supplied for the fiscal years 1993, 1994, 1995, 1996, and 1997 in Part 1. The total number of agency physicians actually receiving or expected to receive PCA should be supplied for the fiscal years 1993, 1994, 1995, 1996, and 1997 in Part II. The same data should be provided by category for each of the fiscal years.
(2) 
Number of Physicians Signing One-Year and Two-Year PCA
: Under the PCA program, physicians may elect to sign a one-year or two-year PCA service agreement. For those physicians actually 
receiving
 or expected to receive PCA (Part II), the number of physicians signing one-year and two-year agreements should be supplied for each fiscal year.
(3) 
Average Compensation per Physician
: Average annual compensation per physician should 
exclude
 the PCA bonus, but include base pay and all other bonuses and awards. The average compensation for agency physicians 
eligible
 for PCA should be supplied for the fiscal years 1990, 1991, 1992, 1993, and 1994 in Part I. The average compensation for agency physicians actually 
receiving
 or expected to receive PCA should be supplied for the fiscal years 1993, 1994, 1995, 1996, and 1997 in Part II. The same data should also be provided 
by category
 for each fiscal year.
(4) 
Average PCA Amount per Physician, by Category
: The average annual PCA bonus paid per physician for all categories, as well as for each individual category of physician, should be supplied for each fiscal year in Part II.
(5) 
Average PCA Amount per Physician, by Length of Service Agreement
: The average annual PCA bonus paid per physician should be supplied for physicians with a one-year service agreement and two-year service agreement and for each fiscal year in Part II.
(6) 
Average PCA Amount per Physician, by Length of Federal Service
: The average annual PCA bonus paid per physician with (a) less than two years creditable Federal service, and (b) two or more years creditable Federal service, should be supplied for each fiscal year in Part II.
(7) 
Average Number Years Continuous Service
: The average number of years of continuous creditable Federal service as a physician for those eligible (Part I) and actually receiving or expected to receive PCA (Part II) should be supplied for each fiscal year. The average should be calculated as of the end of the fiscal year in question (e.g. for an agency with one eligible physician who began Federal service as a physician under the General Schedule on October 1, 1995, would have one-year creditable Federal service for purposes of PCA for fiscal year 1997).
(8) 
Number of Accessions
: The total number of accessions for all physicians (Part I) and for those 
receiving
 PCA (Part II) should be supplied for each fiscal year. The number of accessions by category for each fiscal year should also be supplied.
(9) 
Number of Separations
: The total number of separations for all physicians (Part I) and for those 
receiving
 PCA (Part II) should be supplied for each fiscal year. The number of separations by category for each fiscal year should also be supplied.
(10) 
Number of Unfilled Full-Time Equivalent Physician Positions
: The number should be equivalent to the total number of physician positions for which the agency has budgeted for the fiscal year in question less the number of physicians on-board during the fiscal year. For ,example, the agency may have budgeted for 12 full-time equivalent physician positions for the prior fiscal year, but had only 9.5 physicians on-board for the entire year (9 physicians on-board the entire year, and one on-board for six-months of the year). The number of unfilled full-time equivalent physician positions in this case is equal to 2.5.
The total number for all physicians (Part I) and for those 
receiving
 PCA (Part II) should be supplied for each fiscal year. The number by category for each fiscal year should also be supplied.
(11) 
Average Length of Time Physician Positions Remained Unfilled
: The time should be reported in months as of the end of the fiscal year (e.g., as of the end of the prior fiscal year the average length of time vacant physician positions remained unfilled might be 13 months, and for the current fiscal year it may have declined to an average of 8 months). Only the time during which the agency was actively searching for candidates should be counted. The total number for all physicians (Part I) and for those 
receiving
 PCA (Part II) should be supplied for each fiscal year. The number by category for each fiscal year should also be supplied.

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

AUG. 8, 1996

OFFICE OF THE DIRECTOR

Honorable Newt Gingrich Speaker of the House of Representatives Washington, DC. 20515

Dear Mr. Speaker:

The purpose of this letter is to transmit a report by the Office of Management and Budget on Physicians Comparability Allowances (PCA's), as required by section 5948 (j) of title 5, United States Code. The report was prepared by the Office of Management and Budget using data gathered from those agencies with approved plans.

The enclosed report describes which agencies have entered into PCA agreements, the recruiting and retention problems justifying their use, the number of physicians entering into PCA agreements, the size of the allowances provided and the duration of the agreements, and the degree to which recruiting and retention problems are alleviated by the allowance.

Sincerely,   /S/ James B. King Director

Enclosure

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

AUG. 8, 1996

OFFICE OF THE DIRECTOR

 Honorable Albert Gore, Jr.  President of the Senate  Washington, DC. 20510 
Dear Mr. President:

The purpose of this letter is to transmit a report by the Office of Management and Budget on Physicians Comparability Allowances (PCA's), as required by section 5948 (j) of title 5, United States Code. The report was prepared by the Office of Management and Budget using data gathered from those agencies with approved plans.

The enclosed report describes which agencies have entered into PCA agreements, the recruiting and retention problems justifying their use, the number of physicians entering into PCA agreements, the size of the allowances provided and the duration of the agreements, and the degree to which recruiting and retention problems are alleviated by the allowance.

Sincerely,   /S/  James B. King  Director

Enclosure
Presidential Report on the Physicians' Comparability Allowance
**Introduction**

Public Law 103-114 requires the President to report to Congress on the operation of the Physicians' Comparability Allowance (PCA), including information on:
- which agencies use the allowance;
- the recruiting and retention problems justifying these agencies' use;

- the number of physicians receiving the allowance;

- the size and duration of the agreements entered into;

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

To prepare this report, OMB asked all agencies with PCA-eligible physicians to provide data on:
- the number of physicians they employ, the type of work they do (clinical, research, occupational health or disability evaluation), how many of these are eligible for the bonus and how many actually receive it;
- the average compensation (excluding PCA bonuses) of physicians receiving and not receiving the bonus, the size of the average PCA bonus, and the size of bonuses provided physicians by category of work and length of PCA agreement;

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

- descriptions of the work done by their physicians receiving PCA, and the recruiting and retention problems justifying payment of PCA bonuses.

Using these data, the report describes the use of the PCA bonus by Federal agencies. It also addresses the Federal physician recruiting and retention situation, and the effectiveness of the bonus in improving the situation.
**Background**
The Physicians' Comparability Allowance authorizes agencies documenting severe recruitment and retention problems to pay annual bonuses to physicians, up to $14,000 per year for physicians with less than two years Federal service and up to $20,000 for physicians with more than two years Federal service. The PCA was originally authorized by P.L. 95-603 in 1978 (5 U.S.C. 5948) and has been reauthorized a number of times, including 1979, 1981, 1983, 1987, 1990 and 1993. Most of the reauthorizations were simple extensions of the PCA authority. The 1987 reauthorization doubled the maximum allowable bonuses to the current levels. The current authority extends to September 30, 1997.
The PCA is authorized only to solve severe, documented physician position recruitment and retention problems. For the purpose of this allowance, severe recruitment and retention problems are considered to exist if all of the following conditions exist: long-lasting position vacancies; high turnover rates in positions requiring well qualified physicians; applicants do not have the superior qualifications necessary for the position; and existing vacancies cannot be filled with well qualified candidates without use of PCA.
**Federal Physicians Receiving the Physicians' Comparability Allowance Fiscal Years 1992 to 1996**FY 1992 (Actual)FY 1993 (Actual)FY 1994 (Actual)FY 1995 (Actual)FY 1996  (Est.)Number of Physicians Eligible2,9772,9422,9872,9132,936Number Receiving PCA1,8691,8911,8852,0151,952% of Eligible Receiving PCA63%64%63%69%66%Average Compensation (PCA Excluded)$73,655$78,852$84,604$90,616$91,396Average PCA$14,495$14,694$14,103$16,723$17,334 Source: OMB data collection from agencies. Data for FY 1996 = estimated. 
Summary of PCA Usage Throughout the Federal Government

As of FY 1995, the last year for which we have complete data, 2,015 physicians in federal employment received a PCA bonus, out of 2,913 eligible. The average bonus paid was $16,723. The largest users of PCA were the Department of Health and Human Services, which gave bonuses to 1,193 physicians and the Department of Defense, which gave bonuses to 480 physicians.
The recruiting and retention problems justifying these bonuses vary widely. Some agencies have physician personnel difficulties because they require physicians with special expertise such as aeronautics or agriculture. Other agencies have difficulty because they require physicians to live and work in remote areas. Still other agencies have difficulties because local competition for physicians has driven salaries past the standard government pay scale.
The number of physicians receiving PCA has risen slightly from FY 1992 to FY 1995. Estimates for FY 1996 show a slight decline from FY 1995. Their average compensation (excluding PCA) has risen and estimates for FY 1996 show this rise continuing.
From FY 1992 (actual) to FY 1996 (estimates) PCA has constituted a fairly constant 16% of the income of those who receive it. The one exception is FY 1994, in which PCA constituted 14% of receiving physicians' compensation

Physicians Signing One Year and Two Year AgreementsFY 1992 (Actual)FY 1993 (Actual)FY 1994 (Actual)FY 1995 (Actual)FY 1996 (Est.)Signing One-Year AgreementsNumber 132187175330342Average Bonus$10,673$10,195$10,928$12,104$13,139Signing Two-Year AgreementsNumber1,5681,6441,6401,6741,611Average Bonus$15,338$15,192$15,681$17,909$17,953 Source: OMB data collection from agencies. Data from FY 1996 are estimated.  Some agencies did not provide all of the requested data.
Most of the use of PCA has been among physicians signing two-year agreements. The increase in one-year agreements in FY 1995 is largely due to HHS almost doubling the number of one-year agreements they made from FY 1994 to FY 1995. Also, in FY 1995 the State Department moved to one-year instead of two-year agreements.
The data on personnel activity show relatively stable patterns since FY 1992 -- and show that positions receiving PCA generally have lower turnover than those eligible but not receiving it. In FY 1995, accessions to positions eligible for PCA were 19% of the total, and separations were 23%. For positions receiving PCA, accessions were 15% of the total, and separations were 11%.
The percentage of PCA-eligible positions that are unfilled has fallen since 1992, from 13% in FY 1992 to 9% in FY 1995. This decrease appears to be a result of Federal Government downsizing rather than from an increase in positions filled. As a result of downsizing, for example, HHS has reduced its number of unfilled positions from 365 in FY 1994 to 174 in FY 1995. (Estimates for FY 1996 show a slight increase over FY 1995).
**National Physician Supply and Salary**
Data on the number of physicians in Federal employment by specialty are not available, though anecdotal evidence and agency reports suggest most are general practitioners. Because this data is not available, direct comparison of incomes with physicians in private practice is not possible. However, in 1994, all U.S. non-Federal physicians earned an average income (after expenses and before taxes) of $182,400. Physicians in general or family practice earned an average income (after expenses, before taxes) of $121,200.
1/ In 1994, a total of 653,851 physicians were professionally active in the United States.2/1. Source: American Medical Association, "Physician Marketplace Statistics 1995," p.101.2. Health: United States: 1995; U.S. Department of Health an Human Services; p.220.Federal Physicians Separations, Accessions, Unfilled Positions FY 1992(Actual)FY 1993(Actual)FY 1994(Actual)FY 1995(Actual)FY 1996(Est.)Number of Physicians Eligible2,9772,9422,9872.9132,936% of Eligible Receiving PCA63%64%63%69%66%AccessionAmong Eligible Physicians608738684565666% of Eligible Physicians20%25%23%19%23%Among PCA Physicians294259208294229% of Receiving Physicians16%14%11%15%12%SeparationsAmong Eligible Physicians398735582672653% of Eligible Physicians13%25%20%23%22%Among PCA Physicians168210162219280% of Receiving Physicians9%11%9%11%14%Unfilled PositionsAmong Eligible Physicians389483548266302% of Eligible Physicians13%16%18%9%10%Among PCA Physicians281282310217249% of Receiving Physicians15%15%16%11%13%**Source**: OMB data collectionfrom agencies with approved PCA plans.  Data for FY 1996 are estimated. Some agencies did not provide all of the requested data.
**Summary** -- Effectiveness of PCA

As the narratives provided below show, Federal agencies employ physicians in a wide variety of geographic areas to serve multiple functions. This diversity presents federal policy for the recruitment and retention of physicians with numerous challenges and opportunities. Data show that in FY 1995 accessions, separations, and unfilled positions made up a larger percentage of positions eligible for PCA than did those actually receiving the bonus. The lower percentage of accessions among positions receiving PCA is inconclusive, as it could reflect the greater difficulties in recruiting for those positions, or greater stability in them. The lower percentage of separations among positions receiving PCA suggests that the PCA may have helped improve retention. The data suggest PCA serves more as a tool for the retention of physicians than for their recruitment.
Summary of Agency PCA Reports
**Agencies with PCA Eligible Physicians**

Executive Order No. 12109, signed on December 28, 1978, delegates PCA authority granted to the President under 5 U.S.C. 5948 to the Directors of the Office of Personnel Management (OPM) and the Office of Management and Budget (OMB). The following agencies employ physicians eligible for PCA (listed in descending order of number of physicians receiving PCA in FY 1995):
Department of Health and Human Services Department of Defense Department of Justice Department of State Department of Transportation Central Intelligence Agency US Agency for International Development Department of Labor Armed Forces Retirement Homes Social Security Administration Environmental Protection Agency Department of Veterans Affairs Department of Agriculture Department of Energy Department of the Treasury Library of Congress NASA Tennessee Valley Authority
**Summary descriptions of their use of the PCA follow.**

**Department of Health and Human Services**

HHS employs the largest number of physicians eligible for and receiving the PCA. HHS reports that these physicians perform a variety of tasks and possess skills of considerable value outside Federal employment. For example, the National Institutes of Health, "a worldwide leader in biomedical research .... recruits physicians with outstanding research competence." It must compete with the academic community for these physicians. Likewise the Food and Drug Administration must compete with pharmaceutical companies for physicians qualified to support the regulation of food, prescription and over the counter drugs, and medical devices. On the other hand, the Indian Health Service provides clinical care to a large population, much of which is scattered over long distances in remote areas.
In FY 1995, the Department of Health and Human Services (HHS) provided PCA bonuses to 1,193 physicians out of 1,903 eligible. The average bonus was $14,912, and the average compensation (not including the bonus) of physicians receiving the bonus was $89,590. In the same year, HHS had 205 accessions, 139 separations, and 156 unfilled positions. The average length of vacancy was six months.
**Department of Defense**
In FY 1995, the Department of Defense provided PCA bonuses to 480 physicians out of 602 eligible. The average bonus was $11,886, and the average compensation (not including the bonus) of physicians receiving the bonus was $74,906. In the same year the Department had 50 accessions, 62 separations, and 26 unfilled positions. While the Department did not report the average the average length of vacancy, this time varied from three months to two years.
**Department of Justice**
The Bureau of Prisons within the Justice Department employs physicians to provide health care services to inmates. The Bureau states that these physicians work under difficult conditions such as rigid work schedules and environments, close contact with a potentially dangerous and violent population, increased exposure to infectious disease, and negative public perception of correctional work.
In FY 1995, Justice provided PCA bonuses to 181 physicians out of 198 eligible. The average bonus was $15,700 and the average compensation (not including the bonus) of physicians receiving the bonus was $106,000. The department reported 40 accessions and 43 unfilled positions in FY 1995, but had no information on the number of separations.
**Department of State**
The State Department reports that its physicians working overseas advise diplomatic staff on foreign policy questions having medical importance, provide medical care for American employees and their dependents, provide emergency medical support to foreign posts, monitor quality of care in embassy health units, and maintain liaison with local physicians, hospitals and public health officials. Physicians working at headquarters oversee the State Department's Medical Program, determine medical clearances, coordinate and oversee medical evacuations, and provide occupational health services to headquarters employees. The Department says that recruiting and retaining physicians is difficult because "government service overseas, with its disruptive elements, threats of personal security, separation from family, reduction in income, and intellectual and professional isolation, is an unattractive option for most experienced physicians." Also, physicians working in headquarters have management skills which make them very attractive to private sector employers.
In FY 1994, the Department of State provided PCA bonuses to 64 physicians, out of 65 eligible. The average bonus was $17,000, and the average compensation (not including the bonus) of physicians receiving the bonus was $104,616. In the same year, the Department had three accessions, three separations, and four unfilled positions. The average length of vacancy was five months.
**Department of Transportation**
The Department of Transportation reports that the Federal Aviation Administration (FAA) operates an office primarily concerned with the human element in flight: the pilots, the passengers, the air traffic controllers, and the entire human support system. FAA provides a wide range of medical, research, and safety programs to support safety in civil aviation. According to FAA, experienced physicians are extremely valuable because the agency has focused its resources on fewer, highly qualified physicians. Even with the PCA, insufficient remuneration continues to be the principal source of physician dissatisfaction. FAA states that the success it has had in retaining physicians is primarily due to their personal interest in aviation and a sense of public service, but without PCA, the difference in salary rates could negate these other considerations.
In FY 1995, the Department of Transportation paid PCA bonuses to 38 physicians, out of 38 eligible. The average bonus was $20,000 and the average compensation of physicians (not including the bonus) was $83,837.
**Central Intelligence Agency (CIA)**
The CIA reports that it requires PCA pay to attract and retain physicians because of specialized security and travel requirements. In FY 1995, the CIA paid PCA bonuses to all 25 eligible physicians. The average bonus was $19,040 and the average non-PCA compensation of the physicians receiving it was $94,170. The CIA reported two accessions, two separations, and 13 unfilled positions in FY 1995.
**U.S. Agency for International Development (AID)**
According to AID, one of the reasons for its difficulty in recruiting physicians is the agency's need for physicians with highly specialized skills. Specific expertise is required in such areas as epidemiology, preventive medicine, international health, tropical medicine, and infectious disease. These technical skills often must be combined with management/administrative skills and a knowledge of international development, as well as interpersonal skills and stature to interact with developing-country colleagues. According to AID, the agency is at a serious financial disadvantage in competing for such physicians compared to international agencies such as the World Health Organization.
With so few physicians working for AID, the workload is especially demanding and difficulty retaining staff is directly related to demands made on AID physicians.
In FY 1995, AID provided bonuses to all eligible physicians, a total of eight. The average bonus was $19,260, and the average compensation (not including the bonus) of physicians receiving PCA was $86,984. In FY 1995, AID had two separations and one unfilled position; the average length of vacancy for physician positions was five months.
**Department of Labor**
DOL reports that it uses the PCA in hiring physicians for the Office of Worker's Compensation Programs (OWCP). Because of OWCP's unique requirements, it has been traditionally difficult to recruit physicians who are qualified and interested in this type of work. Past recruitments indicate that the OPM Medical Officer registers do not include candidates with the experience and knowledge necessary for OWCP positions. To obtain qualified candidates, DOL has contacted such organizations as the American Association of Occupational Health Physicians, the American Academy of Orthopedic Surgeons, local chapters of the American Medical Association, and several medical schools. Most physicians contacted through these means have declined employment, citing low salary as the main reason for their refusal. In many instances, these physicians' expected salaries are one and a half to two times higher than the rate for GS-14, step 1.
In FY 1995, the Department of Labor provided PCA bonuses to eight physicians, out of 11 eligible. Their average bonus was $15,400, and average compensation (not including the bonus) was $90,225. The Department had once accession, two separations, and five unfilled position in FY 1995.
**Armed Forces Retirement Homes**
The Armed Forces Retirement Homes consist of the United States Naval Home (USNH) and the U.S. Soldiers' and Airmen's Home (USSAH). In FY 1995 the Armed Forces Retirement Homes had ten physicians eligible for PCA. Of these, eight physicians received the PCA. The USSAH reports that it needs to pay PCA to attract specialists in the competitive and expensive Washington area.
The USNH reports that due to the nature of the health/medical problems it addresses, staff physicians require in-depth family practice experience and a thorough understanding of geriatric medicine. Local physicians with this background and experience make between $150,000 and $200,000 per year. The local Veterans Affairs hospital hires physicians at $71,000 to $84,000 per year and can award recruitment and retention bonuses ranging from $15,000 to $45,000.
The USNH hires physicians at $55,000 to $60,000. Even with the PCA, the USNH states that it has difficulty recruiting the caliber of physician to provide the highest standard of care to USNH residents.
**Social Security Administration**
Social Security Administration (SSA) physicians receiving PCA are medical specialists who establish the medical criteria used to evaluate the severity of medical impairments of applicants for and beneficiaries of payments under the disability program administered by SSA. The specialists conduct studies, keep abreast of modern medicine and interface with the medical community to ensure that the medical criteria of the SSA disability program reflect the latest advances in medicine. Without a PCA, SSA would not be able to recruit and retain qualified physicians (who must be American Board Certified and experienced in their specialties) since Administrative medicine is not that attractive to physicians, especially in SSA where doctors are not integrated into the academic, research or clinical fields.
In FY 1995, the first year during which the Social Security Administration was separated from the Department of Health and Human Services, SSA provided PCA bonuses to seven physicians out of 11 eligible. Their average bonus was $14,285, and average compensation (not including the bonus) was $92,112. SSA had two separations and no accessions or unfilled positions in FY 1995.
**Environmental Protection Agency**
In FY 1995, the Environmental Protection Agency provided PCA bonuses to six physicians out of seven eligible. The average bonus was $15,583 and the average compensation (not including the bonus) of physicians receiving the bonus was $85,978. The department reported one accession and no unfilled positions or separations in FY 1995.
**Department of Veterans Affairs**
While physicians working in Veterans hospitals are paid in a separate pay system, the Department does employ some physicians who are paid according to the General Schedule. These physicians may be eligible for the PCA. In FY 1995 the Department of Veterans Affairs provided PCA bonuses to two physicians, out of two eligible for the bonus. The average bonus was $20,000, and the average compensation (not including the bonus) was $96,990. In FY 1995, the Department had one accession, one separations, but no unfilled vacancies.
**Department of Agriculture**
USDA reports it has one employee, working for the Agricultural Research Service, who receives PCA. USDA says it has had difficulty filling this post, which requires a physician, who is also a human nutrition researcher. Qualified applicants have not been willing to locate to the USDA facility in North Dakota. In addition, the University of North Dakota, the chief competitor for physicians and researchers in this area, pays salaries considerably higher that the GS - GM 15 salary for this position.
In FY 1995, USDA paid a PCA bonus of $20,000 to the physician, whose other compensation was $92,058. USDA had no separations, and no unfilled positions, in FY 1995.
**Department of Energy**
The Department did not provide a PCA bonus to any of its three eligible physicians in FY 1995. In the same year, it had no accessions, separations, or unfilled positions.
**Department of the Treasury**
In FY 1995 the Department of the Treasury did not provide a PCA bonus to either of its two physicians eligible for PCA.
**Library of Congress**
The Library of Congress employs one physician eligible for PCA but does not provide the bonus.
**NASA**
In FY 1995, NASA employed 28 physicians eligible for PCA but did not provide PCA bonus pay.
**Tennessee Valley Authority**
In FY 1995 the TVA employed eight PCA-eligible physicians but did not provide PCA bonus pay.
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