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Not All Federal Physicians Eligible for Extra Pay Allowance Actually Get It
- Categorized in: Bureau of Prisons, Department of Defense (DoD), Department of Veterans Affairs (VA), NIH, September 2011
WASHINGTON — Of the nearly 19,482 full-time civilian physicians employed by the federal government, about 9% were eligible for Physicians Comparability Allowance (PCA) payments, but only 7% actually received it in FY 2010.
That information was included in an annual report on the PCA this summer by the Office of Personnel Management. The report found that the largest users of PCA were the Department of the Army, Bureau of Prisons, and the NIH. These agencies comprised of 62% of all PCA recipients.
The report also showed that, while the number of physicians receiving PCA increased from FY 2009 to FY 2010 from 1,274 to 1,419, the number of physicians eligible to receive the payment dropped from 3,196 to 1,833.
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The PCA statute authorizes federal agencies documenting severe recruitment and retention problems to pay an allowance to physicians up to $14,000 per year for physicians with 24 months or less of service as a government physician and up to $30,000 per year for physicians with more than 24 months of service as a government physician.
For FY 2010, 849 physicians in DoD were eligible for PCA, while only 646 received it. In HHS, 596 physicians were eligible for PCA, while 418 actually received it. For Bureau of Prisons, 220 were eligible, while 201 received it.
Dennis Boyd, executive director for the Federal Physicians Association, said it is possible that some physicians eligible for PCA pay may not have received it if an agency stipulated that it does not have a recruitment or retention problem. Or, in the case of DoD, where there might be only one physician at an installation, it is possible that the installation commander might not know the PCA exists, he added.
According to the report, “PCA-eligible physicians were generally covered by Title 5, United States Code, as General Schedule employees of Senior Executive Service members. Most of the non-PCA Federal civilian physicians are covered by the Department of Veterans Affairs physicians pay system.”
Boyd told U.S. Medicine that his organization would like to see OPM’s annual report on the PCA replaced by one that includes the pay of all civilian physicians in the federal government, sorted by medical specialty and geographic area.
“We really want that report scrapped altogether in favor of a report that covers all types of physician pay, including Title 38, Title 42 and Title 5. We want it, if we could get it by specialty and geographic area, because so much of physician pay is pending on market pay,” he said.
The FPA believes a more comprehensive annual report would be a first step in helping eliminate federal physician pay inequities by educating physicians on what they should be paid, he said.
“Otherwise, physicians have no idea what their pay should be based on the pay of their colleagues,” said Boyd. “There is nothing for a physician to look at say, ‘Well I am in this specialty, I have this many years and I am in this geographical area.’ Nowhere can you find any information on what your colleagues are being paid, so you don’t know whether you are getting overpaid or underpaid or what.” http://www.fedphy.org/
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I joined the VA as a physician at a VA hospital in a known shortage area- we are classed not as rural medicine, but as frontier medicine- WITHIN CONUS. No recognition is given that many of our veterans travel 3-4 hours to recieve care here, not even by our own administration (100 miles away). Our budget is judged by how much is fee-based out compared to "major medical centers" who have a full complement of specialty and subspecialty physicians, access to the "academic centers" as alluded to above who have the staffing to do proceedures internally. Despite all this, we are the ONLY JACOH approved facillity for 50 miles one direction, 150 miles the other. I consider that our physician, mid-level, and nursing/support staff do an outstanding job with the resources we have to work with. I would make more than $30,000/yr more WITHIN THE VA if I were to relocate to a larger center. I am not trying to make a case for more $ for me, but rather ANY appreciation even from local Administration for what the staff here is able to accomplish despite being repeatedly refused ability to hire staff, even part time, to utillize the facillities and equipment (CT, Ultrasound, Endoscopy, etc) we already have on site.
As a 16-year VA physician employee (internal medicine and endocrinology) my opinion is that VA physicians are paid adequate salaries right now, given all the advantages they have compared with private sector care colleagues, especially in primary care, even though their hours worked has been increasing. In the not so distant past, VA physicians were paid less than their private peers, so there was difficulty in recruiting and retaining excellent providers (e.g., many VAs in underserved areas had to recruit foreign medical graduates to make up for the lack of American graduates willing to work at the VA). Thinks have changed in the last decade, as VA compensation has gone up and private physicians work more and more hours struggling with ever increasing difficulty securing Medicare/Medicaid and private insurance compensation, especially in primary care. Hours worked for compensation received are comparable to, or even less, than at the VA, when you factor in all the compensation related administrative burdens private providers have. This is at a time when VA physicians enjoy decent salaries with generous paid annual and sick leave, administrative leave for CME, no need to struggle with billing issues, maternity leave ( quite a few young physicians hire on as new VA docs and then have maternity leaves with job security without losing patients, which would be difficult to do in private practice), and fairly regular hours with cross-coverage available in most locations and opportunities for academic enrichment in univerity-affiliated VAs. VA doctors also enjoy the unique, unquantifiable privilege of caring for America's veterans, be they veterans of Battle of the Bulge to elite OEF/OIF Special Operations warriors. Things are changing, however, in the doctor-patient relationships VA physicians have, as more and more administrative burdens and barriers are piled on to providers, often with a "top down" approach (e.g., documentation and questionably beneficial health care maintenance monitoring requirements, prescribing restrictions which are increasingly arbitrary, and the perception that physicians are not highly educated intelligent professionals but generic laborers who require control and management at the same level as janitors or maintenace workers). Front-line providers are feeling ever more frustrated in their ability to "be a doctor" and not have the doctor-patient relationship excessively interfered with. Ultimately, it is of course a balancing act, for each doc to decide if it is worth it for him or her to stay at the VA. If they are staying , for whatever reason, as I am, it is worth it to them (indeed, if things are on balance too miserable, docs -- and NPs/PAs for that matter -- can leave for "greener" pastures, or retire early, and as I understand it there has not been a mass exodus of physicians -- yet -- especially in today's economy). I suspect most docs (at least in the non-procedural fields ) would stay on even if their pay were cut a small percentage (I am not advocating this) , but there are limits. Hopefully, there will not be attrition of the best docs in future years, or a diminution in the quality of care delivered, which is not always measurable by computer critieria such as per cent of pts receiving flu shots and undergoing MST screening compliance data. Good docs need to have a sense that they have a voice and independence in deciding how to care for their patients, even in a large bureaucracy such as the VA, or the amount of compensation and other benefits they receive will not make up for their loss of professional integrity. It is not just about money.
Where I work at there are some outpatient physicians who do not take calls or do not go on duty at the hospital, although more than likely they are being paid at the same rate as the others who go on weekend/holiday duties/calls. Most of us who work full time are obligated to go on duty/oncall in the hospital on holidays/weekends without pay of course. Of course those who do not even do duty or call work outside their full time work also get the same bonus pay. Plus, these privileged ones are almost always absent and the ones who are diligent and are always present have to cover all the time and do extra work.
physicians are not the only providers
the nurse practitioners and physician assistants are required to perform the same duties at significant less pay with NO pay for performance bonuses. So why are you excluding the other primary patient providers in this discussion when we are impacted the same?