US public health service needs reform

Congress created the Department of Defense in 1947. Nearly 40 years later, Sen. Barry Goldwater (R-Ariz.) and Rep. Bill Nichols (D-Ala.) proposed and shepherded through Congress significant changes in its structure, creating the modern DoD.

The U.S. Public Health Service was created by Congress in 1889 and has grown to its present form and size without comprehensive Congressional guidance. The PHS has served our country well — if anonymously — during the current pandemic, but it is in dire need of reform, in the manner of a Goldwater-Nichols Act. 

I am an outsider, not a PHS officer, but I served for six years as the executive director of the non-profit organization that represents the officers of the USPHS. As someone with a military background, I am suggesting some changes in the PHS that would make it more efficient and effective as a uniformed service that fights our nation’s wars against disease:

Support personnel 

The PHS is about 98 percent frontline personnel at present, a much larger percentage than in any military services. This sounds great, but it means that physicians and nurses and dentists serve at PHS headquarters doing personnel work and dispatching officers to far-flung locations around the globe. This is a total waste of talent and education. A cadre of support personnel should be created.

Public affairs specialists

Every other service has professionals that tell the taxpayer what they are doing for them. The PHS keeps its activities hidden and shuns publicity. This needs to change.

Inspector general and RR/EO offices

I know from their complaints that officers in the PHS have nowhere to turn when they are not treated according to law and regulation. Every other service has professionals to whom their service personnel can go for help. The PHS should be no different.

Leadership training

PHS officers are well-trained medical professionals, but they are not natural leaders. The military services understand that leadership can be taught, and the PHS should do the same, perhaps by allowing its officers to attend military schools.

A budget line

Most people — even on Capitol Hill — would be amazed to learn that the Surgeon General has no line in the HHS budget. The SG has to depend on “fees” charged to the agencies and departments that employ PHS officers just to run his small office. The budget line would not have to be huge, but it should be consistent. When he wanted to deploy officers to Liberia during the Ebola pandemic in 2014, the Surgeon General didn’t have any funds to send them to a short pre-deployment training. He had to beg the CDC for funding.

Career leadership

Federal law (42 U.S. Code 205) states that the Surgeon General is to come from the ranks of the U.S. Public Health Service. This statute dates from 1944, and every president has violated it since Richard Nixon. Yes, we’ve had some good political appointees as Surgeon General, such as Dr. C. Everett Koop, Dr. Richard Carmona, and Dr. David Satcher. But we have had others who were monumentally unsuited to be “the nation’s doctor.” 

As someone who spent 30 years in the Army, I find it absurd to see an “instant admiral” created at the three-star level by presidential nomination and Senate confirmation. I can only imagine what the three-stars who have earned their rank through long service are thinking as they sit at the table with this political appointee: “I worked my butt off to get to this rank, and he/she makes it because they worked on a political campaign or knew the Vice President.” The PHS deserves better.

The ongoing pandemic has demonstrated the worth of the officers of the USPHS as little else could have done. It is a satisfactory service that could be much better with a congressional champion or two and with some targeted changes in its structure. Public Health is a bipartisan issue, so reform of the USPHS could be an excellent task for a group of lawmakers to undertake in the 117th Congress.  

Col. James T. Currie, U.S. Army (Ret.), Ph.D., was executive director of the Commissioned Officers Association of the U.S. Public Health Service from 2014-2020.

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