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OMB Bulletin No. 98-05

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|T H E   W H I T E   H O U S E                                          | OMB Bulletin No. 98-05        | Help

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|May 4, 1998 
 
BULLETIN NO. 98-05 
 
TO THE HEADS OF EXECUTIVE DEPARTMENTS AND ESTABLISHMENTS 
 
SUBJECT: Physicians Comparability Allowance Data Reporting Requirements 
 
1. Purpose. This Bulletin, which includes Attachments A through C, provides detailed instructions on 
agency data reporting requirements regarding operation of the Physicians Comparability Allowance 
(PCA) program. The Bulletin is issued pursuant to the 1997 edition of OMB Circular A-11, section 
13.2(b)(12). 
 
Collection of the data by OMB is required to monitor government-wide PCA usage, physician 
employment, and physician compensation. The data will be used to evaluate the effect of the PCA on 
Federal physician recruitment and retention and to issue the 1998 Presidential Report on the Physicians' 
Comparability Allowance in accordance with the Federal Physicians Comparability Allowance Act of 
1978 Extension (P.L. 105-61). 
 
2. Background. On October 10, 1997, the President signed P.L. 105-61, reauthorizing the Federal 
Physicians Comparability Allowance until September 30, 2000. This Act extends authority to pay 
annual bonuses for Federal physicians serving in areas or specialties with documented recruitment and 
retention problems. 
 
Office of Personnel Management (OPM) regulations implementing PCA require OMB approval of 
agency plans to pay bonuses. OPM regulations implementing the PCA are published in 5 C.F.R. 595. 
 
OMB is collecting data on PCA program operation and Federal physician recruitment and retention to 
ensure consistent government-wide implementation and to evaluate the effectiveness of the PCA 
program. 
 
3. Due Date. Agencies must submit the requested data by May 29, 1998. FY 1999 PCA Plans must 
be submitted by September 15, 1998. 
 
4. Termination Date. This Bulletin will terminate as soon as the requested data have been submitted. 
 
Franklin D. RainesDirectorAttachments 
 
ATTACHMENT A 
 
Agencies with currently approved PCA Plans 
 
Department of Defense 
Department of Energy 
Department of Health and Human Services 
Department of Labor 
Department of State 
Department of Transportation 
Social Security Administration 
Department of Veterans AffairsAgencies that have employed or now employ physicians eligible for PCA 
 
Agency for International Development 
Central Intelligence Agency 
Department of Agriculture 
Department of Justice 
Department of Treasury 
Environmental Protection Agency 
Library of Congress 
National Aeronautics and Space Administration 
Tennessee Valley Authority 
United States Soldiers' and Airmen's HomeNOTE: Agencies not listed that employ physicians eligible for PCA are also covered by this Bulletin. 
 
ATTACHMENT B 

Physicians Comparability Allowance (PCA) Report and Worksheets 
 
Authority. 
 
5 U.S.C. 5948 authorizes payment of physicians comparability allowance to eligible individuals paid as 
physicians under the following pay systems: General Schedule; administratively determined pay for 
certain specially qualified scientific or professional personnel; Tennessee Valley Authority Act; Foreign 
Service Act; CIA Act; section 121 of title 2 of the Canal Zone Code; or section 2 of the Act of May 
29, 1959, relating to the National Security Agency. 
 
P.L. 100-140, the Federal Physicians Comparability Allowance Amendments of 1987, amended 5 
U.S.C. 5948 to provide a maximum PCA of $14,000 per year for physicians with less than 24 months' 
Federal service, and $20,000 per year for physicians with 24 or more months' Federal service. P.L. 
100-140 also allows physician service in the Department of Veterans Affairs and the Public Health 
Service Commissioned Corps to be creditable towards 24 months Federal civilian service when 
calculating maximum PCA allowance eligibility.  P.L. 105-61 reauthorized PCA until September 30, 
2000. 
 
Executive Order No. 12109 delegates authority granted the President under 5 U.S.C. 5948 to the 
Directors of the Office of Personnel Management and the Office of Management and Budget. 
 
5 C.F.R. 595 sets additional requirements for agency implementation of 5 U.S.C. 5948, including 
agency reporting requirements. 
 
OMB Circular A-11, 13.2(b)(12), requires agencies to reflect approved plans to pay bonuses in annual 
budget estimates in accordance with P.L. 100-140 and P.L. 105-61. 
 
Coverage. This Bulletin covers all agencies that employ physicians eligible for PCA. This includes both 
agencies with currently approved PCA plans that are eligible to pay PCA bonuses, whether or not they 
actually do pay the bonuses, and agencies without approved plans that employ physicians eligible for 
PCA. Attachment A lists those agencies that currently have an approved PCA plan, as well as agencies 
that do not currently have an approved plan but are known to have employed physicians eligible for 
PCA. Agencies not listed that employ physicians eligible for PCA are still covered by this Bulletin. 
 
Submission Requirement. (1) Each agency should review and update the 1997 PCA reporting 
worksheet submitted by that agency. (Copies of the 1997 data have been given to the appropriate 
OMB staff. Agencies should contact their OMB examiners if they need a copy of the 1997 data.) 
Please verify that all FY 1994 - FY 1997 figures in the worksheet are correct and add a new column 
providing FY 1998 estimates. See below for instructions on how to calculate figures. 
 
(2) Review the attached copies of the 1997 Presidential Report on the PCA (Attachment C). Verify 
and update the text for your agency that appears in the section entitled "Summary of Agency PCA 
Reports," pp. 6 to 11. 
 
Submit the revisions to the PCA Report and PCA worksheet to the OMB examiner responsible for that 
agency. 
 
Information Contact: Inquiries should be addressed to Melany Nakagiri, telephone (202) 3954926.Instructions for Preparing Worksheets 
 
General guidance 
 
The data requested should be supplied for all Federal physicians eligible for PCA, and as a subset. all 
Federal physicians actually receiving PCA. Eligibility for PCA is defined in 5 U.S.C. 5948 and 5 C.F.R. 
595. 
 
Data for the budget year should be the estimates included in budget formulation where applicable (e.g., 
average PCA per physician, average compensation, etc.) or the agency's best estimate (e.g., number of 
accessions anticipated). Agency estimates may simply be the average of the previous fiscal years. All 
dollars should be on an obligational basis, and all employment numbers should be on a full-time 
equivalent (FTE) basis unless otherwise noted. 
 
Several sections of the worksheet request data by physician category. Some agencies may not employ 
physicians in all categories, but complete data should be provided for those physician categories 
applicable to the agency. 
 
Definitions-General 
 
Government Physician. 5 U.S.C. 5948(g)(1) defines Government physician as any individual paid as a 
physician under the following pay systems: General Schedule; administratively determined pay for 
certain specially qualified scientific or professional personnel; Tennessee Valley Authority Act; Foreign 
Service Act; CIA Act; section 121 of title 2 of the Canal Zone Code; or section 2 of the Act of May 
29, 1959, relating to the National Security Agency. 
 
Creditable Federal Service. For purposes of PCA bonus calculations under 5 U.S.C. 5948, as 
amended by P.L. 100-140, creditable federal service includes service as a Government physician in any 
of the personnel systems established under authorities listed immediately above, as well as service as a 
physician in the Department of Veterans Affairs and the Public Health Service Commissioned Corps. 
 
Definitions-Physician Categories 
 
Category I-Clinical Positions: Positions primarily involving the practice of medicine as a direct service to 
patients, including the performance of diagnostic, preventive, or therapeutic services to patients in 
hospitals, clinics, public health programs, diagnostic centers, and similar settings. 
 
Category II-Research Positions: Physician positions primarily involving research and investigative 
assignments. 
 
Category III-Occupational Health: Physician positions primarily involving the evaluation of physical 
fitness, the provision of initial treatment of on-the-job illness or injury, or the performance of 
pre-employment examinations, preventive health screening, or fitness-for-duty examinations. 
 
Category IV-Disability Evaluation and Administration of Health and Medical Programs: 
 
Subcategory IV A: Physician positions primarily involving disability evaluation. 
 
Subcategory IV B: Physician positions primarily involving the administration of health and medical 
programs, including but not limited to a chief of professional services, senior medical officer, or 
physician program director position.Description Worksheets to Be Submitted to OMB 
 
(1) Total Number Employed: The total number of agency physicians eligible for PCA (includes all 
eligible physicians, whether or not they actually received PCA bonuses) should be supplied for the fiscal 
years 1994, 1995, 1996, 1997, and 1998 in Part 1. The total number of agency physicians actually 
receiving or expected to receive PCA should be supplied for the fiscal years 1994, 1995, 1996, 1997, 
and 1998 in Part II. The same data should be provided by category for each of the fiscal years. 
 
(2) Number of Physicians Signing One-Year and Two-Year PCA: Under the PCA program, physicians 
may elect to sign a one-year or two-year PCA service agreement.  For those physicians actually 
receiving or expected to receive PCA (Part II), the number of physicians signing one-year and two-year 
agreements should be supplied for each fiscal year. 
 
(3) Average Compensation per Physician: Average annual compensation per physician should exclude 
the PCA bonus, but include base pay and all other bonuses and awards. The average compensation for 
agency physicians eligible for PCA should be supplied for the fiscal years 1994. 1995, 1996, 1997, and 
1998 in Part I. The average compensation for agency physicians actually receiving or expected to 
receive PCA should be supplied for the fiscal years 1994, 1995, 1996, 1997, and 1998 in Part II. The 
same data should also be provided by category for each fiscal year. 
 
(4) Average PCA Amount per Physician, by Category: The average annual PCA bonus paid per 
physician for all categories, as well as for each individual category of physician, should be supplied for 
each fiscal year in Part II. 
 
(5) Average PCA Amount per Physician, by Length of Service Agreement: The average annual PCA 
bonus paid per physician should be supplied for physicians with a one-year service agreement and 
two-year service agreement and for each fiscal year in Part II. 
 
(6) Average PCA Amount per Physician, by Length of Federal Service: The average annual PCA 
bonus paid per physician with (a) less than two years creditable Federal service, and (b) two or more 
years creditable Federal service, should be supplied for each fiscal year in Part II. 
 
(7) Average Number Years Continuous Service: The average number of years of continuous creditable 
Federal service as a physician for those eligible (Part I) and actually receiving or expected to receive 
PCA (Part II) should be supplied for each fiscal year. The average should be calculated as of the end of 
the fiscal year in question (e.g. for an agency with one eligible physician who began Federal service as a 
physician under the General Schedule on October 1, 1996, would have one-year creditable Federal 
service for purposes of PCA for fiscal year 1998). 
 
(8) Number of Accessions: The total number of accessions for all physicians (Part 1) and for those 
receiving PCA (Part II) should be supplied for each fiscal year. The number of accessions by category 
for each fiscal year should also be supplied. 
 
(9) Number of Separations: The total number of separations for all physicians (Part I) and for those 
receiving PCA (Part II) should be supplied for each fiscal year. The number of separations by category 
for each fiscal year should also be supplied. 
 
(10) Number of Unfilled Full-Time Equivalent Physician Positions: The number should be equivalent to 
the total number of physician positions for which the agency has budgeted for the fiscal year in question 
less the number of physicians on-board during the fiscal year. For example, the agency may have 
budgeted for 12 full-time equivalent physician positions for the prior fiscal year, but had only 9.5 
physicians on-board for the entire year (9 physicians on-board the entire year, and one on-board for 
six-months of the year). The number of unfilled full-time equivalent physician positions in this case is 
equal to 2.5. 
 
The total number for all physicians (Part I) and for those receiving PCA (Part II) should be supplied for 
each fiscal year. The number by category for each fiscal year should also be supplied. 
 
(11) Average Length of Time Physician Positions Remained Unfilled: The time should be reported in 
months as of the end of the fiscal year (e.g., as of the end of the prior fiscal year the average length of 
time vacant physician positions remained unfilled might be 13 months, and for the current fiscal year it 
may have declined to an average of 8 months). Only the time during which the agency was actively 
searching for candidates should be counted. The total number for all physicians (Part I) and for those 
receiving PCA (Part II) should be supplied for each fiscal year. The number by category for each fiscal 
year should also be supplied. 
 
UNITED STATES 
OFFICE OF PERSONNEL MANAGEMENT' 
WASHINGTON. D.C. 20415 
 
JULY 18, 1997 
 
OFFICE OF THE DIRECTOR 
 
Honorable Newt Gingrich 
Speaker of the House of Representatives 
Washington, DC 20515 
 
Dear Mr. Speaker: 
 
The purpose of this letter is to transmit a report on Physicians Comparability Allowances (PCA's),**as 
required by section 5948(j) of title 5, United States Code. The report was prepared by the Office of 
Management and Budget using data gathered from those agencies with approved plans. 
 
The enclosed report describes which agencies have entered into PCA agreements, the recruiting and 
retention problems justifying their use, the number of physicians entering into PCA agreements and the 
duration of the agreements, the size of the allowances provided, and the degree to which recruitment 
and retention problems are alleviated by the allowance. 
 
The report also recommends a simple 3-year reauthorization of the PCA authority to September 30, 
2000. Under the current PCA authority (5 U.S.C. 5948), no PCA service agreement may be entered 
into later than September 30, 1997. 
 
Sincerely, 
  /S/
James B. King 
DirectorEnclosure 
 
**Presidential Report on the Physicians Comparability Allowance** 
 
**Introduction** 
 
Public Law 103-114 requires the President to report to Congress on the operation of the Physicians 
Comparability Allowance (PCA), including information on: 
 
which agencies use the allowance;
the nature and extent of recruiting and retention problems justifying the use of the allowance by each 
agency;
number of physicians with whom agreements were entered into by each agency; 
size of the allowances and duration of the agreements; 
and the degree to which the allowance alleviates recruiting and retention problems.To prepare this report, the Office of Management and Budget (OMB) asked all agencies with PCA 
eligible physicians to provide data on: 
 
number of physicians they employ, type of work they do (clinical research, occupational health or 
disability evaluation), how many are eligible for the allowance and how many actually receive it; 
average compensation (excluding PCA) of physicians receiving and not receiving the allowance, size 
of the average PCA, and size of allowances provided to eligible physicians by category of work and 
length of PCA agreement; 
average number of years of continuous service per physician, number of accessions and separations 
the agency experienced, number of unfilled physician positions and average length of time positions 
were vacant; 
descriptions of the physicians' work, and recruiting and retention problems justifying payment of 
PCA.Using these data, the report describes the use of PCA by Federal agencies. It also addresses the 
Federal physician recruiting and retention situation, and the effectiveness of PCA in improving the 
situation. 
 
**Reauthorization of PCA** 
 
Under 5 U.S.C. 5948, the current PCA authority extends to September 30, 1997. Based on 
information presented in this and previous reports to Congress, PCA has been effective in assisting 
Federal agencies to address recruitment and retention problems for physicians. Consistent with these 
findings, the Administration supports a simple, 3-year reauthorization of PCA to September 30, 2000. 
The simple reauthorization will allow OMB and the Office of Personnel Management (OPM) to 
continue to monitor the impact of PCA on the recruitment and retention of Federal physicians. 
 
**Background** 
 
The Physicians Comparability Allowance authorizes agencies documenting severe recruitment and 
retention problems to pay annual bonuses to physicians, up to $14,000 per year for physicians with less 
than two years Federal service and up to $20,000 for physicians with more than two years Federal 
service. PCA was originally authorized by P.L. 95-603 in 1978 (5 U. S. C. 5 94 8) and has been 
reauthorized a number of times, including 1979, 1981, 1983, 1987, 1990 and 1993. Most of the 
reauthorizations were simple extensions of the PCA authority. The 1987 reauthorization doubled the 
maximum allowable bonuses to the current 1evels. 
 
PCA is authorized only to solve severe, documented physician recruitment and retention problems. For 
the purpose of this allowance, severe recruitment and retention problems are considered to exist if all of 
the following conditions exist: long-lasting position vacancies; high turnover rates in positions requiring 
well-qualified physicians; applicants do not have the superior qualifications necessary for the position; 
and existing vacancies cannot be f:illed with well-qualified candidates without PCA. Some agencies use 
alternative programs to improve recruitment and retention of physicians such as the physician special 
pay authority under title 38, United States Code, that are not covered by this report. 
 
**Summary of PCA Usage Throughout the Federal Government** 
 
Table 1. Number and Compensation of Federal Physicians Receiving PCA 
 
Federal Physicians Receiving the Physicians Comparability Allowance 
Fiscal Years 1993 to 1997FY 1993 
(Actual) 
FY 1994 
(Actual) 
FY 1995 
(Actual) 
FY 1996 
(Actual) 
FY 1997 
(Est)Physicians Eligible 
2,952 
2,975 
2.916 
2,402 
2,580Physicians Receiving 
1,896 
1,890 
2,014 
1,841 
1,793% of Eligible Receiving 
64% 
64% 
69% 
77% 
69%Average Compensation (PCA excluded) 
$77,777 
$83,283 
$86.188 
$88,761 
$90,141Average PCA 
$14,698 
$14,124 
$14,541 
$15,765 
$15,373Source: OMB data collection from Federal agencies using PCA. Data for FY 1997 are estimated. 
Some agencies did not provide all of the requested data.As of FY 1996, the last year for which we have complete data, 1,841 physicians in Federal 
employment received PCA, out of 2,402 who were eligible. The average allowance paid was $15,765. 
The largest users of PCA were the Department of Health and Human Services (HHS), which gave 
bonuses to 1,019 physicians and the Department of Defense, which gave bonuses to 487 physicians. 
 
The recruiting and retention problems that justify the allowance vary greatly. Some agencies require 
physicians with special expertise such as aeronautics or agriculture. Other agencies require physicians to 
live and work in remote areas. Still other agencies suffer difficulties because local non-Federal 
competition for physicians has driven salaries past the standard government pay scale. 
 
The percentage of physicians receiving PCA has risen from FY**1994 to FY 1996, but estimates for FY 
1997 indicate a decline from FY 1996. The average compensation (excluding PCA) for physicians has 
risen consistently over the years, and estimates for FY 1997 indicate this trend will continue. From FY 
1994 to FY 1997, PCA has constituted roughly 17% of the income of the physicians who receive the 
allowance. 
 
Table 2. Data on Number and Compensation of Federal Physicians by Length of Agreement 
 
Physicians Signing One-Year and Two-Year PCA Agreements  
Fiscal Years 1993 to 1997FY 1993 
(Actual) 
FY 1994 
(Actual) 
FY 1995 
(Actual) 
FY 1996 
(Actual) 
FY 1997 
(Est.)Signing 
One-Year 
Agreements 
Physicians 
187 
175 
275 
221 
243Average Bonus 
$10,088 
$10,814 
$10,129 
$11,892 
$12,826Signing 
Two-Year 
Agreements 
Physicians 
1,687 
1,673 
1,679 
1.614 
1,520Average Bonus 
$15,252 
$15,718 
$16,534 
$16,982 
$15,881Source: OMB data collection from Federal agencies using PCA. Data from FY 1997 are estimated. 
Some agencies did not provide all of the requested data.Most of the use of PCA has been among physicians signing two-year agreements. The number of 
one-year contracts dropped by nearly 20% in FY 1996, primarily due to an increase in the use of other 
pay authorities by HHS (the largest user of PCA). The number of two-year contracts declined slightly in 
FY 1996 as well FY 1997 estimates predict a 9% increase in the number of one-year agreements and a 
6% decrease in the number of two-year agreements. 
 
The data on personnel activity show that physicians receiving PCA generally have lower turnover rates 
than those who are eligible but not receiving the allowance. In FY 1996, new accessions accounted for 
24% of the number of physicians eligible for but not receiving PCA. Of the physicians eligible for but 
not receiving PCA, 26% separated from Federal service in FY 1996. The turnover rate among 
physicians receiving PCA in FY 1996 was slightly lower than the rate for physicians eligible for but not 
receiving PCA. New accessions accounted for 18% of the physicians receiving PCA, with an equal 
percentage of physicians receiving PCA separating from Federal service in FY 1996. 
 
The percentage of PCA eligible positions that were unfilled fell from 19% in FY 1994 to 9% in FY 
1995, but rose to 12% in FY 1996. While the decrease in the number of vacant positions in FY 1995 
was more the result of Federal government downsizing than an actual increase in positions filled, the 
fluctuation in unfilled positions continues in FY 1997. Preliminary FY 1997 data predict a decline in 
unfilled positions from FY 1996. 
 
Table 3. Data on Accessions, Separations, and Vacancies in Positions Eligible for or Receiving PCA 
 
Federal Physicians Accessions, Separations, and Unfilled Positions 
Fiscal Years 1993 to 1997FY 1993 
(Actual) 
FY 1994 
(Actual) 
FY 1995 
(Actual) 
FY 1996 
(Actual) 
FY 1997 
(Est.)Number of Physicians Eligible 
2.952 
2,975 
2,916 
2,402 
2,580Number of Physicians Receiving PCA 
1,896 
1,890 
2,014 
1,841 
1,793% of Eligible Receiving PCA 
64% 
64% 
69% 
77% 
69%Accessions 
Among Eligible 
738 
686 
562 
565 
573% of Eligible 
25% 
23% 
19% 
24% 
22%Among PCA 
261 
211 
294 
327 
228% of Receiving 
14% 
11% 
15% 
18% 
13%Separations 
Among Eligible 
740 
583 
674 
629 
591% of Eligible 
25% 
20% 
23% 
26% 
23%Among PCA 
214 
163 
219 
324 
292% of Receiving 
11% 
9% 
11% 
18% 
16%Unfilled Positions 
Among Eligible 
495 
560 
266 
288 
256% of Eligible 
17% 
19% 
9% 
12% 
10%Among PCA 
294 
323 
217 
209 
179% of Receiving 
16% 
17% 
11% 
11% 
10%Source: OMB data collection from Federal agencies using PCA. Data for FY 1997 are estimated. Some agencies did 
not provide all of the requested data.**National Physician Supply and Salary** 
 
Data on the number of physicians in Federal employment by specialty are not available, though 
anecdotal evidence and agency reports suggest most are general practitioners. Because these data are 
not available, it is not possible to compare the income of Federal physicians with that of private practice 
physicians. However, according to a study conducted by the American Medical Association, U.S. 
non-Federal physicians earned an average net income (after expenses and before taxes) in 1995 of 
$195,000, a 7.2% increase over 1994 income levels. Physicians in general or family practice earned an 
average income (after expenses, before taxes) of $124,000.1/ In 1995, the most recent data available, 
a total of 681,694 physicians were professionally active in the United States.2/ 
 
**Summary - Effectiveness of PCA** 
 
The FY 1996 data demonstrate that PCA contributes to improved recruitment and retention of Federal 
physicians. For example, in FY 1996, the turnover rate among those eligible for but not receiving PCA 
was greater than the turnover rate among physicians receiving the allowance. In addition, over the past 
several years, three-fourths of all eligible physicians have chosen to enter into service agreements and 
receive PCA. However, the data also indicate that there are other factors outside PCA which influence 
physicians' decisions to enter Federal service and, therefore, also affect their recruitment and retention. 
For example, the higher percentage of accessions among physicians eligible for but not receiving PCA 
indicate that physicians choose to enter into Federal service in spite of PCA. 
 
As the narratives provided on the following pages indicate, Federal agencies employ physicians in a 
wide variety of geographic areas to serve multiple functions. This diversity presents numerous challenges 
and opportunities to Federal policy for the recruitment and retention of physicians. PCA is one of many 
methods used by Federal agencies to address these recruitment and retention challenges. Based on the 
findings in this report, the Administration supports a simple 3-year reauthorization of the PCA authority 
to September 30, 2000. 
 
1.American Medical Association Center for Health Policy Research: *American Medical News*, Jan. 6, 1997. 
 
2.U.S. Department of Health and Human Services: *Health: United States* 1996, Unpublished 1995 data. 
Summary of Agency PCA Reports
 
Agencies with PCA Eligible Physicians 
 
Executive Order No. 12109, signed on December 28, 1978, delegates PCA authority granted to the 
President under 5 U.S.C. 5948 to the Directors of the OPM and OMB. The following agencies employ 
physicians eligible for PCA (listed in descending order of number of physicians receiving PCA in FY 
1996): 
 
Department of Health and Human Services Department of Defense 
Department of Justice 
Department of State 
Department of Transportation 
NASA 
Central Intelligence Agency 
Department of Labor 
Social Security Administration 
Armed Forces Retirement Home 
U.S. Agency for International Development 
Environmental Protection Agency 
Department of Energy 
Tennessee Valley Authority 
Department of Veterans Affairs 
Department of Agriculture 
Library of Congress 
Department of the TreasurySummary descriptions of each agency's use of PCA: 
 
Department of Health and Human Services (HHS)HHS employs the largest number of physicians eligible for and receiving PCA. Physicians perform a 
variety of tasks and possess skills of considerable value outside Federal employment. For example, the 
National Institutes of Health, "a worldwide leader in biomedical research" must compete with the 
academic community to recruit physicians with outstanding research competence. Likewise the Food 
and Drug Administration must compete with pharmaceutical companies for physicians qualified to 
support the regulation of food, prescription and over the counter drugs, and medical devices. 
Additionally, the Indian Health Service provides clinical care to a large population, much of which is 
scattered over long distances in remote areas. 
 
In FY 1996, HHS provided PCA to 1,019 out of 1,363 eligible physicians. HHS attributes the decline 
in the number of physicians receiving PCA in FY 1996 to the increased use of other pay authorities, 
such as physicians special pay under title 38, United States Code. The average allowance was 
$16,277, and the average compensation (not including the allowance) of physicians receiving PCA was 
$93,223). Among physicians receiving PCA, HHS had 229 accessions, 235 separations, and 149 
unfilled positions. The average length of vacancy was six months. 
 
Department of Defense 
 
In FY 1996, the Department of Defense provided PCA to 487 physicians out of 633 eligible. The 
average allowance was $13,878 and the average compensation (not including the allowance) of 
physicians receiving PCA was $76,578. In the same year the Department had 49 accessions and 75 
separations. 
 
Department of Justice 
 
The Bureau of Prisons employs physicians to provide health care services to inmates. These physicians 
work under difficult conditions such as rigid work schedules and environments, close contact with a 
potentially dangerous and violent population, increased exposure to infectious disease, and negative 
public perception of correctional work. 
 
In FY 1996, Justice provided PCA bonuses to 183 physicians out of 198 eligible. The average 
allowance was $16,200 and the average compensation (not including the allowance) of physicians 
receiving PCA was $92,700. The Bureau had 40 accessions and 46 unfilled positions in FY 1996, but 
provided no information on the number of separations. 
 
Department of State 
 
State Department physicians working overseas advise diplomatic staff on foreign policy questions 
having medical importance, provide medical care for American employees and their dependents, 
provide emergency medical support to foreign posts, monitor quality of care in embassy health units, 
and maintain liaison with local physicians, hospitals and public health officials. Physicians working at 
headquarters oversee the State Department's Medical Program, determine medical clearances, 
coordinate and oversee medical evacuations, and provide occupational health services to headquarters 
employees. According to the State Department, recruiting and retaining physicians is difficult because 
"government service overseas, with its disruptive elements, threats of personal security, separation from 
family, reduction in income, and intellectual and professional isolation, is an unattractive option for most 
experienced physicians." 
 
In FY 1996, the Department of State provided PCA to 54 physicians, out of 60 eligible. The average 
allowance was $17,500, and the average compensation (not including the allowance) of physicians 
receiving PCA was $99,126. In the same year, the Department had five accessions, three separations, 
and two unfilled positions. The average length of vacancy was five months. 
 
Department of Transportation 
 
The Federal Aviation Administration (FAA) provides a wide range of medical, research, and safety 
programs to support safety in civil aviation. According to FAA, experienced physicians are extremely 
valuable because the agency has focused its resources on fewer, highly qualified physicians. Even with 
the PCA, insufficient compensation continues to be the principal source of physician dissatisfaction. 
FAA states that the success it has had in retaining physicians is primarily due to their personal interest in 
aviation and a sense of public service, but without PCA, the difference in salary rates could negate these 
other considerations. 
 
In FY 1996, the Department of Transportation provided PCA to all of the 35 eligible physicians. The 
average allowance was $19,000 and the average compensation of physicians (not including the 
allowance) was $86,000. 
 
NASA 
 
NASA is not participating currently in the PCA program. In FY 1996, NASA employed 26 physicians 
eligible for PCA and had one unfilled position. NASA did not provide PCA to any physicians. 
 
Central Intelligence Agency (CIA) 
 
Because of specialized security and travel requirements, CIA relies upon PCA to attract and retain 
physicians. In FY 1996, CIA provided PCA to 25 out of 26 eligible physicians. The average bonus 
was $18,690 and the average non-PCA compensation of the physicians receiving it was $94,171. In 
FY 1996, CIA reported no accessions, no separations, and 10 unfilled positions. 
 
Department of Labor (DOL) 
 
The Department of Labor uses PCA in hiring physicians for the Office of Worker's Compensation 
Programs (OWCP). Because of OWCP's unique requirements, it has been difficult to recruit physicians 
who are qualified and interested in this type of work. The Occupational Safety and Health 
Administration (OSHA) and the Mine Safety and Health Administration (MSHA) also use PCA 
agreements to attract and retain physicians needed to provide medical and epidemiological expertise in 
clinical investigations. 
 
Past recruitments indicate that the OPM Medical Officer registers do not include candidates with the 
experience and knowledge necessary for DOL positions. To obtain qualified candidates, DOL has 
contacted such organizations as the American Academy of Orthopedic Surgeons, local chapters of the 
American Medical Association, and several medical schools. Most physicians contacted through these 
means have declined employment, citing low salary as the main reason for their refusal. In many 
instances, the expected salaries of these physicians are one and a half to two times higher than the rate 
for GS- 14, step 1. 
 
In FY 1996, the Department of Labor provided PCA bonuses to six out of 11 eligible DOL physicians. 
The average allowance paid was $17,481, and the average compensation (not including the allowance) 
was $87,480. In FY 1996, the Department had two separations and one unfilled position. 
 
Social Security Administration (SSA) 
 
Social Security Administration physicians receiving PCA are medical specialists who establish the 
medical criteria used to evaluate the severity of medical impairments of applicants for and beneficiaries 
of payments under the disability program administered by SSA. The specialists conduct studies, keep 
abreast of modem medicine and interface with the medical community to ensure that the medical criteria 
of the SSA disability program reflect the latest advances in medicine. Without PCA, SSA would not be 
able to recruit and retain qualified physicians (who must be American Board Certified and experienced 
in their specialties) since physicians are not attracted to administrative medicine, especially in SSA 
where doctors are not integrated into academic, research or clinical fields.  In FY 1996, SSA provided 
PCA to seven out of 10 eligible physicians. The average allowance was $15,000, and the average 
compensation (not including the allowance) for physicians receiving PCA was $94,641. SSA had two 
separations and no accessions or unfilled positions in FY 1996. 
 
Armed Forces Retirement Homes 
 
The Armed Forces Retirement Homes (AFRH) consist of the United States Naval Home (USNH) and 
the U.S. Soldiers' and Airmen's Home(USSAH). In FY1996, AFRH had ten physicians eligible for 
PCA. Of these, eight physicians received PCA. The USSAH reports that it must offer PCA to attract 
specialists in the competitive and expensive Washington area. USNH has one vacancy and AFRH is 
not recruiting for the vacancy. 
 
U.S. Agency for International Development (AID) 
 
According to AID, one of the reasons for its difficulty in recruiting physicians is the agency's need for 
physicians with highly specialized skills. Specific expertise is required in areas such as epidemiology, 
preventive medicine, international health, tropical medicine, and infectious disease. These technical skills 
often must be combined with management/administrative skills and a knowledge of international 
development, as well as interpersonal skills and stature to interact with developing country colleagues. 
According to AID, the agency is at a serious financial disadvantage in competing for such physicians 
compared to international agencies such as the World Health Organization. 
 
With so few physicians working for AID, the workload is especially demanding and difficulty in retaining 
staff is directly related to demands made on AID physicians. 
 
In FY 1996, AID provided allowances to all seven eligible physicians. The average allowance was 
$19,710, and the average compensation (not including the allowance) of physicians receiving PCA was 
$89,990. In FY 1996, AID had one separation and one unfilled position; the average length of vacancy 
for physician positions was five months. 
 
Environmental Protection Agency (EPA) 
 
In FY 1996, the Environmental Protection Agency provided PCA to six out of seven eligible physicians. 
The average allowance was $15,583 and the average compensation (not including the allowance) of 
physicians receiving PCA was $84,647. EPA reported no accessions, separations, or unfilled positions 
in FY 1996. 
 
Department of Energy 
 
The Department of Energy did not provide PCA to any of its four eligible physicians in FY 1996. The 
Department had no accessions, separations, or unfilled positions. 
 
Tennessee Valley Authority (TVA) 
 
In FY 1996, the TVA employed four PCA-eligible physicians but did not provide PCA. 
 
Department of Veterans Affairs 
 
While physicians working in Veterans hospitals are paid in a separate pay system, the Department does 
employ some physicians who are paid under the General Schedule. These physicians may be eligible for 
PCA. In FY 1996, the Department of Veterans Affairs provided PCA to all three eligible physicians. 
The average allowance was $20,000, and the average compensation (not including the allowance) was 
$105,177. In FY 1996, the Department had one accession and one separation. A vacancy was unfilled 
for six months. 
 
Department of Agriculture (USDA) 
 
USDA employs one physician in the Agricultural Research Service. According to USDA, the 
Department has had difficulty filling this post in the past because it requires a physician who is also a 
human nutrition researcher. Qualified applicants often are not willing to relocate to the USDA facility in 
North Dakota. In addition, the University of North Dakota, the chief competitor for physicians and 
researchers in this area, pays salaries considerably higher than the GS-15 salary for this position. 
 
In FY 1996, USDA paid an allowance of $20,000 to the physician, whose other compensation was 
$94,006. USDA had no separations and no unfilled positions in FY 1996. 
 
Library of Congress 
 
In FY 1996, the Library of Congress employed one physician eligible for PCA but did not provide 
PCA. 
 
Department of the Treasury 
 
In FY 1996, the Department of the Treasury employed one physician eligible for PCA, but did not 
provide PCA. 



The Budget
 | 
Legislative Information
 | 
Management Reform/GPRA
 | 
Grants Management
Financial Management
 | 
Procurement
        Policy
 | 
Information &
        Regulatory Policy

Privacy Statement | Federal Physicians Receiving the Physicians Comparability Allowance 
Fiscal Years 1993 to 1997 |                   | FY 1993 
(Actual) | FY 1994 
(Actual) | FY 1995 
(Actual) | FY 1996 
(Actual) | FY 1997 
(Est) | Physicians Eligible | 2,952 | 2,975 | 2.916 | 2,402 | 2,580 | Physicians Receiving | 1,896 | 1,890 | 2,014 | 1,841 | 1,793 | % of Eligible Receiving | 64% | 64% | 69% | 77% | 69% | Average Compensation (PCA excluded) | $77,777 | $83,283 | $86.188 | $88,761 | $90,141 | Average PCA | $14,698 | $14,124 | $14,541 | $15,765 | $15,373 | Physicians Signing One-Year and Two-Year PCA Agreements  
Fiscal Years 1993 to 1997 |  | FY 1993 
(Actual) | FY 1994 
(Actual) | FY 1995 
(Actual) | FY 1996 
(Actual) | FY 1997 
(Est.) | Signing 
One-Year 
Agreements | Physicians | 187 | 175 | 275 | 221 | 243 | Average Bonus | $10,088 | $10,814 | $10,129 | $11,892 | $12,826 | Signing 
Two-Year 
Agreements | Physicians | 1,687 | 1,673 | 1,679 | 1.614 | 1,520 | Average Bonus | $15,252 | $15,718 | $16,534 | $16,982 | $15,881 | Federal Physicians Accessions, Separations, and Unfilled Positions 
Fiscal Years 1993 to 1997 |  | FY 1993 
(Actual) | FY 1994 
(Actual) | FY 1995 
(Actual) | FY 1996 
(Actual) | FY 1997 
(Est.) | Number of Physicians Eligible | 2.952 | 2,975 | 2,916 | 2,402 | 2,580 | Number of Physicians Receiving PCA | 1,896 | 1,890 | 2,014 | 1,841 | 1,793 | % of Eligible Receiving PCA | 64% | 64% | 69% | 77% | 69% | Accessions | Among Eligible | 738 | 686 | 562 | 565 | 573 | % of Eligible | 25% | 23% | 19% | 24% | 22% | Among PCA | 261 | 211 | 294 | 327 | 228 | % of Receiving | 14% | 11% | 15% | 18% | 13% | Separations | Among Eligible | 740 | 583 | 674 | 629 | 591 | % of Eligible | 25% | 20% | 23% | 26% | 23% | Among PCA | 214 | 163 | 219 | 324 | 292 | % of Receiving | 11% | 9% | 11% | 18% | 16% | Unfilled Positions | Among Eligible | 495 | 560 | 266 | 288 | 256 | % of Eligible | 17% | 19% | 9% | 12% | 10% | Among PCA | 294 | 323 | 217 | 209 | 179 | % of Receiving | 16% | 17% | 11% | 11% | 10%
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| ---------------------------------------------------------------------------------------------- | ----------------- | ----------------- | ----------------- | ----------------- | ----------------- | -------------- | ------------------- | ----- | ----- | ----- | ----- | ----- | -------------------- | ----- | ----- | ----- | ----- | ----- | ----------------------- | --- | --- | --- | --- | --- | ----------------------------------- | ------- | ------- | ------- | ------- | ------- | ----------- | ------- | ------- | ------- | ------- | ------- | ----------------------------------------------------------------------------------- |  | ----------------- | ----------------- | ----------------- | ----------------- | --------------- | ----------------------------- | ---------- | --- | --- | --- | --- | --- | ------------- | ------- | ------- | ------- | ------- | ------- | ----------------------------- | ---------- | ----- | ----- | ----- | ----- | ----- | ------------- | ------- | ------- | ------- | ------- | ------- | --------------------------------------------------------------------------------------------- |  | ----------------- | ----------------- | ----------------- | ----------------- | --------------- | ----------------------------- | ----- | ----- | ----- | ----- | ----- | ---------------------------------- | ----- | ----- | ----- | ----- | ----- | --------------------------- | --- | --- | --- | --- | --- | ---------- | -------------- | --- | --- | --- | --- | --- | ------------- | --- | --- | --- | --- | --- | --------- | --- | --- | --- | --- | --- | -------------- | --- | --- | --- | --- | --- | ----------- | -------------- | --- | --- | --- | --- | --- | ------------- | --- | --- | --- | --- | --- | --------- | --- | --- | --- | --- | --- | -------------- | --- | -- | --- | --- | --- | ------------------ | -------------- | --- | --- | --- | --- | --- | ------------- | --- | --- | -- | --- | --- | --------- | --- | --- | --- | --- | --- | -------------- | --- | --- | --- | --- | ---
|Federal Physicians Receiving the Physicians Comparability Allowance 
Fiscal Years 1993 to 1997                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | FY 1993 
(Actual)                                                                              | FY 1994 
(Actual) | FY 1995 
(Actual) | FY 1996 
(Actual) | FY 1997 
(Est)   
|Physicians Eligible                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      | 2,952                                                                                          | 2,975             | 2.916             | 2,402             | 2,580            
|Physicians Receiving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            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|% of Eligible Receiving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 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|Average Compensation (PCA excluded)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     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|Average PCA                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             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|Physicians Signing One-Year and Two-Year PCA Agreements  
Fiscal Years 1993 to 1997                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                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Fiscal Years 1993 to 1997                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                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(Actual)                                                                              | FY 1994 
(Actual) | FY 1995 
(Actual) | FY 1996 
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