Starting with the Navy next July, the services will begin a multiyear effort to replace thousands of uniformed medical personnel in base hospitals and clinics with federal civilian hires and, in some cases, private contractors.
This is part of the Bush administration’s plan to “transform” the military, in this case by converting 10 to 12 percent of military medical billets into civilian jobs, which would reduce personnel turbulence in the health care system and, over time, lower personnel costs.
As many as 15,000 jobs could be impacted through 2011 if the Army and Air Force match the Navy, which has identified 5,400 medical positions, out of 41,000, as having no “readiness” mission to justify being filled by uniformed personnel. The Navy said more than 35,000 medical billets must remain military, however, because of the requirement to deploy with the fleet, serve alongside Marines or be sent to bases overseas, when needed.
In recent years, Navy Medicine had identified “nonreadiness” billets with “potential to be converted to civilian or contractor,” said Lt. Cmdr. Tim Weber, head of manpower operations for the Navy’s Bureau of Medicine. It therefore was ready last January when Defense leaders directed it to convert 1,772 medical billets to civilian jobs during July through September 2005.
The remaining 3,643 nonreadiness billets could be converted later in the current budget planning cycle, which runs through 2011.
Army and Air Force medical billet conversions are expected to begin in fiscal 2006 but the number of jobs involved awaits final approval.
The Army medical military-to-civilian conversion initiative, said Virginia Stephanakis, spokesperson for the Army Medical Command, is aimed at freeing up more military personnel to serve in war-fighting units, but without degrading quality of care or access to care for beneficiaries still at home.
“Generally, we will recommend for conversion only those military positions that allow us to meet these goals, and for which the civilian market has available [and] affordable replacements,” said Stephanakis.
Weber emphasized the same points in describing the Navy job shift.
For 2005, the Navy requested $35.8 million to add 1,772 civilian medical workers to its payroll for the last three months of fiscal 2005. That’s an average cost of $20,000 per new employee for the July-through-September quarter, or $80,000 per position annually.
No military personnel will be involuntarily separated for this, Weber said. Because Navy medicine is slightly understaffed, those leaving converted billets will fill existing vacancies in readiness-related billets.
The conversion process, said Weber, is an opportunity for medical commands to reorganize to be more efficient. For example, he said, a hospital converting 10 corpsmen filling administrative billets might decide to hire only five civilian replacements but also three transcription specialists to lighten the paperwork load of physicians.
Every Navy surgeon serves in a readiness billet so none of these jobs will be converted. But 150 primary care physician jobs will be filled by civilians just in the first three months of the plan. Of the 1,772 billets to be converted in late 2005, more than 500 are officers and 1,200 enlisted.
The decision to convert a billet will depend on the availability of a qualified and affordable replacement, Weber said.“We are absolutely not changing the quality of care … We are solely changing the color of the uniform. This is a conversion; this is not a cut.”
This fall the Bureau of Medicine will finalize the list of jobs to be converted in late fiscal 2005, Weber said.
“Then we will look at the people in those billets and work with [the Bureau of Personnel] to ensure that we do everything possible to keep those people at their respective commands,” he said.
The conversion of medical billets, first reported by The Washington Post, is part of a larger Defense Department effort to civilianize as many military billets as possible to make more effective use of uniformed personnel. More than 20,000 jobs are to be converted this year and next.
Weber said the first choice of Navy medicine is to replace military billets with federal General Schedule (GS) civilian employees. Using contractors will is only a second but not a preferred alternative.
Even if all 5,415 “nonreadiness” medical billets are converted by 2011, it will not hinder the Navy’s ability to surge assets for a national emergency or global war, Weber said.
“Navy Medicine’s readiness capability is sized to meet the requirement set by higher authorities,” Weber said.
He noted that Navy hospitals and clinics already have more than 10,000 civilians on staff. Because they fill the same kinds of jobs now marked for conversion, the shift should be uneventful for patients.
Defense officials are said to predict some long-term savings from converting medical staff to civilians, especially through lowered retirement obligations. For now, Navy Medicine sees the shift largely as cost neutral.
Premiums rising
Medicare Part B premiums will make their biggest jump ever in January, rising by 17 percent, or $11.60, to a new monthly rate of $78.20.
The announcement stiffened the resolve of military retirees backing HR 3474, the “Keep Our Promise to America’s Military Retirees” bill. Among other things, HR 3474 would waive Part B premiums for elderly military retirees who need Part B coverage to participate in Tricare for Life.
“Consider this a ‘wake-up call’ (maybe too late) to those who have been watching from the sideline,” said Harry Riley, a spokesman for the Class Act Group of elderly retirees. The group, led by retired Air Force Col. George “Bud” Day, has been fighting in the courts and in Congress for several years to win promised military lifetime health care.
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