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“Transforming the Public Health Service Commissioned Corps: CDC/ATSDR Perspective”

Compilation of Comments Received as of October 2005

In the summer of 2005, the CDC/ATSDR Commissioned Corps Policy Advisory Committee (CCPAC) prepared a white paper for Dr. Gerberding entitled, “Transforming the Public Health Service Commissioned Corps: CDC/ATSDR Perspective.” The purpose of the document was to highlight needs of CDC/ATSDR officers and outline strategies to enhance our effectiveness and value to the agency in the context of the transformation process. Specifically it includes a listing of our attributes, our unique public health perspective, and covers additional topics of leadership, training, visibility and optimizing esprit de corps. Because the CCPAC committee recognized the importance of soliciting and incorporating officers’ feedback, during the fall of 2005, multiple feedback sessions were held, including face-to face brown bag sessions in Atlanta, Cincinnati as well as conference calls for CDC officers assigned outside of Atlanta.

The Committee thanks the nearly 100 officers who provided written feedback and nearly 100 officers who attended the sessions either in person or by phone. A compilation of these comments follows and is organized in the following themes: Recruitment and Retention; Public Health; Readiness; Deployments; Officer Expertise; Comparisons with Civil service; Militarization; Agency Allegiance; Uniform; Career Options for Officers; and Morale.

I. CDC officers’ feedback on Transformation PURPOSE:

A. Inappropriate emphasis on geographical and organizational movement. Should focus on the development of in-depth experience. (NOTE: the MO category is considering removing the programmatic and geographic moves for the promotion precepts. This has not been finalized but is under serious discussion).

B. Public health is MORE than emergency response.

II. CDC officers’ feedback on Transformation PROCESS:

A. Clarify the retirement prohibitions as rehire for CS and commit resources to educate officers on option

B. Somehow address the bait and switch (midstream change of rules) unfairness

1. of new promotion criteria; specifically the “time in service” requirements

2. Three strikes you’re out

3. weekly to daily uniform wear

C. Recommend headquarters consider a Corps media campaign

D. Perception that HQ is striving to clean house for Flag CDC leadership

E. Our PH work is NOT respected as evidenced by brain drain. HQ support will translate into better CDC retention.

F. Need to educate officers on civil servant options if they chose to resign their commission prior to 20years of active duty service.

G. The 6th precept is ill-conceived as giving points for hardship assignments in IHS will ultimately be bad for everyone. The last thing Native Americans need is to be getting their care from a group of officers who are only there for promotion points.

H. Bear in mind that fitness requirements that force out senior officers costs the CC dearly in brain power and gains us nothing that could not be accomplished more readily and competently by military recruits.

I. Perhaps there needs to be a sub-section of the CC that deals exclusively with emergency response. This would allow other officers to do what they are most qualified for, rather than having officers leave public health positions where they are very effective to perform tasks for readiness responses.

J. The transformation process has failed to appreciate or deal with CDC needs.

K. A major problem with transformation is that a great deal of emphasis has been placed on policies for promotion without 1st figuring out what the CC personnel needs are going to be in the future.

L. A critically important function of the CC is to allow the government to reduce the opportunity costs for some types of professions (especially MDs) for considering careers in federal service. This point should be acknowledged somewhere.

M. Transformation has consistently overemphasized emergency response and care for the underserved and largely ignored public health.

III. White Paper – General comments

A. Background/Introduction

1. The background section is good, but is too long.

2. Add to background; strong statement about history of abolishing the corps. Include congressional concerns – readiness standards Oct 2005?

3. Beef up introduction (suggest to use the ppt narrative; reflect issues from the 1996 GAO report; add position papers from COF: recruitment and retention of Health Professionals in CC. Recruitment and selection of PHS CO in the clinical disciplines)

4. Last paragraph sound as if it is written by MD with no input from PhDs. PhD can’t maintain clinical proficiency. Otherwise I very much liked this section.

B. Could use extensive editing. Too much of the document seems self-serving. Dropping a lot of the adjectives would help.

C. Separate internal CDC recs from the external (PHS-wide) recs.

D. Discuss advantage / disadvantage of billet restructuring at CDC

E. Lack of defined career development strategies

F. “Very BIASED report. Add recognition of pay/compensation, time away from agency for deployment, PHS activities etc; costs of immunization.”

G. Reorder document for emphasis but retain categorical grouping (e.g., 3 strikes and frozen is a priority rec but is currently listed “last”).

H. Trim the overall number of recs in overall document if needed for impact/implementation feasibility (e.g., can strike BOTC since there are successful moves to support this rec).

I. 22 recommendations is a lot to digest. They should be prioritized. The white paper should also strike a balance between recommendations that will make Rockville happy (daily uniform wear) and those that are of real importance to CDC officers. As it currently reads, CDC is making a number of “concessions” without asking PHS to change much in how they are implementing the transformation. The document could also be paraphrased to read “we embrace the transformation process”.

J. Better define Public Health in general throughout the document

1. Washington is still under appreciating the role of Applied PH.

2. this is a good place to highlight the role and progress made on the Applied Health Track

3. Add more specifics from IOM report here

4. Integrate CDC/ATSDR mission statements here if feasible

5. There should be more focus on prevention in the background “What is Public Health” section.

6. Add a mention of occupational health as an essential function of PHS.

K. The paper is a good effort but is “disappointingly off target”. The central issue is whether or not CDC public health scientists will be valued in a transformed corps. To date, the actions of the CC leadership have been that they will not and the reaction of CDC officers to the process reflects that sentiment that they are not valued. The fact that this is not the central premise of this document is perplexing to me. This document should lay out the policies and actions required to demonstrate to CDC officers that they will be valued in a transformed CC. Much of what is in the draft appears to be political pandering which won’t help the CC leadership or CDC officers.

L. Some of the recommendations run counter to the 1st goal of recruiting and retaining officers. For example, daily uniform wear for most people is a disincentive. Making members more deployable to duties unrelated to the jobs they are hired to do will make CCO less attractive candidates for jobs. You should separate the recommendations into 2 groups- those that CDC really support as useful to us and those that are added because HHS expects us to get in line.

M. It appears that this report is still predicated on the assumption that most physicians at CDC are engaged in “clinical” activities when many are not. The assumption that we are thus all capable of filling clinical assignments perpetuates the myth that CDC CCOs are primarily of value for their clinical as opposed to their public health skills. This misperception is underscored a bit in this paper and that will only serve to undermine the argument that the CC needs both a clinical and public health track. I think this could be easily corrected to play up the epidemiology response capacity and downplay the clinical. (Note- this point was echoed at the all hands meeting on 9/23 as several officers deployed for Katrina expressed discomfort at the clinical roles they were asked to fill. As a couple of people put it “I would not want me taking care of me!”)

N. Suggest that CCO need to practice 300-400 hrs/year on average to keep up-to-date on skills.

O. We should propose a one time buy-out for all officers who do not agree with transformation and wish to leave the CC. This would greatly improve CC morale.

P. The recommendation that officers include ranks on publications is a reasonable one, but I recently published a paper in EID and when I tried to add my rank, they told me that they would not do it. If this is desired, the CC needs to work with journals and then tell officers how to do it.

Q. Need to emphasize to CC leadership that CCO at CDC provide crucial public health function that is founded on and implemented by collaborative leadership, not a hierarchical “military command” structure.

R. An increased emphasis on the importance of the scientific work of the CCO and a decreased emphasis on “militarization”, rank etc. will be the most effective way to recruit folks like EISOs to the CC.

S. Ensure that promotion and awards recognize effective work in public health.

T. This is a nice paper but seems to skirt the real problems of officers wanting to leave the CC because of the changes and concerns about promotions and the future of the CC. Can we add a discussion of these issues, perhaps in a “challenges” section?

U. The attraction for many CDC CCOs is not the agency or the CC, but the science itself. The best use of CCOs comes when we recruit and retain the best and brightest and then reward their accomplishments. We can’t lose sight of what it takes to get and keep the best scientific minds within PHS.

V. No forum to develop CC camaraderie (aside from BOTC). EIS entry mandated CC commission for pay. No instruction in PHS history or career development / path. Rank does not equal respect (as in military). Scientists foster open dialogue not hierarchal direction. I work extra hours because it is “right”. I strive for excellence irrespective of the uniform wear.

W. There are ways to effectively boost the visibility creativity and career retention of our best scientists, but they are not addressed in this document. For example, promotion should be based on achievements, not mobility.

X. Self nominated awards meaningless, self-aggrandizement rather than professional behavior. Merits of work stand alone. No time to chase awards (esp field officers) or disadvantage due to non CCO supervisors who are unfamiliar with system.

Y. List recommendations in order of importance.

Z. Conclusion – agree that transformation needs to take into account routine public health functions.

AA. CC role in the future of PH – grandiose w/o much substance

IV. White Paper – Suggested additions

A. Recruitment and retention

B. Global nature (literally and figuratively) of CDC’s mission and emphasize CCO contributions (e.g., polio eradication / refugee health / CDC passport capability). Specify CDC’s historical accomplishments and future regarding applied public health.

C. Comment on how much time fulfilling CC requirement takes and how it detracts from our day jobs.

D. We should make the point that these recommendations provide a package of low-cost, high impact actions.

E. In the table of characteristics of CCO we should add that they also can bring perspectives from other agencies.

F. In table 2, add mention of CEUs for other groups like vets, nurses etc.

G. In the background section on culture etc we should add some mention of the benefit of CCOs who will help to knit federal agencies closer together as they move between them and bring one agency’s perspectives to another.

H. The issue of standardizing billets across agencies should be addressed.

V. White Paper – Suggested revisions

A. Uniform wear – not universal agreement. But those who are supportive would like to the additional caveat of sensible exemption in circumstances where uniform wear would impede or harm the mission (e.g., STD interview). Quote DoD example of FBI assignees who are directed to wear civilian clothes for safety and security issues.

1. There were a number of comments that agreed with this recommendation. Many pointed out that the CC is a uniformed service and that everyone knew that when they joined. Just because uniform wear was not enforced before does not make it “unfair” to enforce it now since it has always been a policy of the CC.

2. Overemphasized – gets in the way of bigger issues.

3. Include why we wear the uniform (e.g., pride, elicits public trust, helpful authority such as firefighter etc)

4. “frankly we’re a uniformed service, the daily uniform wear should not even be an issue”

5. Senior officers should be instructed to wear uniform for high level briefing in DC

6. Help officers in obtaining uniform and component (e.g., SHARE store can stock uniforms) and provide training on proper wear.

7. Visibility not equal to uniform wear (e.g., NOAA has daily uniform wear yet very small public awareness or visibility).

8. Be mindful that for some people there is a disconnect between wearing the uniform as a prerequisite to serve the public good.

9. For some officers the uniform is the antithesis of public service (the transformation is de-emphasizing PH so to put it on, diminishes why many people work at CDC/ATSDR).

10. Require uniform wear with public interactions BUT not in the office setting

11. Divorce the concept that CDC joining in a daily uniform wear policy would make us “credible” from a PH standpoint. The merits of our work should be judged for credibility not a superficial measurement.

12. “If some itchy poly/wool blend clothing is what makes us different from CS then we should really question whether or not the Corps should exist”.

13. If we really want the uniform to increase visibility, we need a uniform that does not look just like the Navy’s. It’s hard to argue that the uniform increases our visibility when most people don’t recognize the uniform in the 1st place.

14. The section on visibility with the emphasis on uniform wear “does a disservice” to the many CS at CDC who are “trained, competent professionals who are no less effective or important than CCOs” in fulfilling CDC’s mission. “It is not the uniform, but the person in it that matters”.

15. Senior officers must be pushed to wear the uniform to set an example for junior officers.

16. Uniforms are only helpful in recognizing a team when everyone on the team is wearing one. This is almost never the case for COs who work so closely with CS.

17. Items like uniform wear move the CC closer to the military which generates strong negative feelings for many CDC officers. A policy of daily uniform wear would only alienate more officers and lead to even more brain drain which will, in turn, make it even more difficult to get officers into leadership positions because the smartest officers will be gone.

18. Do not include the uniform recommendation in this document. The issue has been largely discussed and decided and having it here will only serve as a lightening rod and pre-empt our ability to tackle the real issues. If the SG hasn’t required it, why should CDC (Note- I assume this comment was about uniform wear, but it was heard to tell from the way it was phrased in the e-mail).

19. How would a policy for daily wear impact those working in BSL-3 labs or those working with other toxic substances? Will those officers be punished for not wearing the uniform every day?

20. CCO should be visible through their actions, not their dress. I am proud to work with CS colleagues and it seems presumptuous to state that we have increased loyalty to ideals and commitment because we are dressed differently. Some people might be reassured by the uniform, others might not- do we have data on this? This section should focus on the importance of wearing the uniform at appropriate functions to acknowledge the CC and when it will be helpful. Most physicians know there are times when you should wear the white coat and times when you should not.

21. It’s fine to push for mandatory daily wear as long as there is a clear recognition that CCOs should have some latitude in determining when they should not wear the uniform.

22. The best way to improve the visibility of the CC is to restore the stature that the SG’s office had under Dr. Koop- THAT was visibility. Having strong and clear leadership from the top will allow us to make the argument that the uniform enhances visibility- right now we are simply mistaken for navy officers or Delta pilots.

23. Uniform wear is barrier / hinderance to job mission (e.g., marginalized populations)

24. Uniform wear does not equal work integrity, dedication. Many CS colleagues work tirelessly and are dedicated to making the US/word a better and safer place. Suggests PHS logos on polo shirts for field work.

25. Comments included specific uniform infractions at the BB held on 6-20-05 Williams building. Raises point that we need monthly or periodic uniform instruction.

B. Unique characteristics of CCO (compare and contrasted with CS)

1. Emphasize 24./7 availability / value of CCO.

2. Another thing that we should emphasize about CCO is that in addition to being uniquely prepared to respond, they are also highly adaptable because of their broad skills and can transform their response roles as a response progresses. For example clinicians from CDC can provide clinical assistance when needed but can turn around and help set up surveillance systems and investigate outbreaks- thus you get multiple response capabilities by deploying one person. This would seem to be a good idea from a fiscal standpoint as well.

3. #1 – careful to alienate CS. Soften the perception of a “quota system” that might heighten tensions between CC and CS further.

4. cited differences between officers and civil servant are true but mostly irrelevant

5. At NCHS >500 employees but only 12 CCO. Doing anything that smacks of CC favoritism will make it very hard to work comfortably with my colleagues. I would suggest that a recommendation be added that says CC deployments to noted somewhere public so that non-CCO are aware of the extra responsibilities that we have; not just supervisory people.

6. I found many of these points unconvincing esp #1 culture/hx/group identify. In additiona including characteristics that came about because of the transformation (i.e., physical fitness) seems an ineffective way to convince other to take more care in their efforts to transform the corps. Page 5 is full paragraph – I disagree with the implication that “allegiance to the agency is negative. It is healthy and appropriate to form an allegiance within our agency and enables us to do our jobs more effectively. Page 7 – the transformation of the corp is occurring in the context of terrorism, many other threats (over population, global warming) which must not be forgotten in our panic over terrorism. Page 11 – clinical skills apply only to MDs.

7. Table 1 and 2 – break out “new transformed features of the corps” (i.e., physical fitness requirement. Note that they were recently added and comment about their acceptability.

8. Rec #1-4 Why do we need these – sounds like we were asking for special favors.

9. #11, #12 – jargon; difficult to understand

C. Emphasize unique CDC expertise that is available to DHHS (e.g., EHO in Tsunami relief for structural soundness).

D. Emphasize that CDC provides leadership and guidance on disease control and prevention. We are not just conducting research, but we are charting the direction for public health.

E. READINESS

1. Clarify that CDC provided extensive input to ensure that immunization requirements more closely align with existing ACIP guidance

2. Enumerate ways to facilitate readiness (e.g., time built into work day for exercise).

3. CDC must provide on the job time to fulfill readiness requirements and really be supportive of people doing it. It’s not enough to simply pay lip service to giving people time. Perhaps it should even be designated that CCO get X hours per week of “readiness training” time.

4. Ensure supervisors are supportive of time necessary to meet requirements

5. Better system reminder to ensure compliance with expiring BLS, vaccinations, q 3 month sign-on etc.

6. Some CCO still don’t see the need.

7. Jobs are sedentary (8-10 hr in front of computer). Lack of access to exercise equipment. Need support to achieve goals.

8. Before the transformation process started 100% of CDC CCOs were “ready” to deploy or work in a public health emergency. With the new requirements, fewer officers are listed as “ready” and many others have spent valuable time away from doing public health to meet the new bureaucratic requirements. If there was another crisis, CDC CCOs would deploy again, whether they met the requirements or not.

9. We have to be a little careful about touting this as such a unique aspect of the Corps. Civil servants also deploy for CDC and also maintain readiness standards (fit testing, vaccinations).

10. A plea from an international officer to raise the challenges of complying with some of the requirements, especially fit testing and BLS when they are living overseas where such things are not available like they are at CDC.

11. I don’t think we should brag our physical fitness which might not be relevant to the job at hand.

12. Readiness requirements need to be made more relevant to public health.

13. delete physical fitness – there is no value as we are equal to pres fitness council civilian level

F. Deployments

1. Deployments- we need better communication between CDC DEOC and OFRD to ensure that deployments to the DEOC “count” for CDC staff.

2. Officers should be able to count as deployments CDC trips that are part of an emergency response (even outside the DEOC).

3. For deployments, the corps should roster a variety of specialty teams with members who have specific skills from all over HHS. That way, when epi skill are needed there is already a team rostered and ready to meet that need. Should there be some discussion of how new deployment requirements will impact the hiring of CCOs? Won’t these make them less attractive job candidates since they will be serving 2 masters?

4. Clarify deployment credits- CDC deployments should be treated the same as CCRF ones. HHS must be made to understand that CDC CCOs deploy all the time on agency assignments. Why are these less valuable than CC deployments?

5. Compare # hours / # deployments of CCO compared to CS

G. Emergency response

1. Need a stronger rationale for existence of corps outside of emergency response. emphasize importance of non-emergency response (i.e., international response)

2. Need surge capacity team. Other PH emergency need lists are not unique to CC ad are continuous long term contributions.

3. Emergency response should emphasize disease outbreak response as this is really where CDC CCOs excel.

4. Beyond continually emphasizing the CC role in “emergency response” we should also emphasize the CC role in performing “core public health activities” which is the bulk of what we do and no less vital than emergency response.

5. Online training does not equate “proficiency in emergency response”. Biannual / annual training to reinforce training and build camaraderie is welcomed.

6. The emphasis on emergency response as the focus of transformation efforts has taken the CC away from it’s primary mission of protecting public health.

7. We should mode; our function after the US military reserves. Reservists drill 2 days a month and 2 weeks a year and have a point system to measure participation. We could pilot such a system and do 2 day monthly trainings where experts from the various centers can cross train others on emergency preparedness skills. Also, shouldn’t CCO have an equal standing within CDC as our fellow uniformed reserve service members? How does the CDC respond to 2 week annual tours of even extended call ups of 179 days?

8. #9 Enhance availability for training, uniform clinics etc for ALL officers – i.e, non-atlanta based.

H. Mobility

1. Mobility is detrimental to public health if it is simply to advance individual careers. Plus side: clinical skills are transferable worldwide. Downside: public health expertise sometimes=institutional memory; cannot be provided by novice

2. It’s tricky to emphasize geographic flexibility among CDC Corps officers as it seems like the vast majority do not move. We should gather some data about how much geographic mobility there really is before making this point such a key feature of CDC CCOs.

3. The issue of “mobility” is a big one for junior officers and fits with the issue of retention. There must be a way to recognize and promote officers who stay in one field and become SMEs. This is a big issue for CDC officers as for many of us, CDC is the only agency where we can really develop and use our expertise. If mobility is valued more highly than expertise we risk more “brain drain” as people leave the Corps rather than move to another job in an area they don’t really like.

4. The mobility issues with transformation seem to imply that all officers are interchangeable. This is certainly not true at a place like CDC where many officers have very specific expertise. The paper should have a more nuanced discussion of the role of deep expertise in the CC.

5. Increased emphasis on mobility could have a chilling effect on the number of CCO who are capable of assuming the very highest levels of leadership.

6. Encouraging people to move around arbitrarily for promotion points will diminish CCO SME and will therefore ultimately weaken the ability of CCO to help further CDC’s mission. The expertise of very specialized officers who leave to advance careers cannot be duplicated by EISOs or new recruits brought in to fill the positions- that expertise will be gone from the agency. While details to other agencies can be useful, I fail to see how permanent changes advance the goals of the CDC and public health. I fail to see how CCPAC can assert that mobility itself enhances public health. If this paragraph on mobility did not intend to imply permanent job changes, it should be revised.

7. We should push to eliminate the mobility requirements for scientific billets. We should review how the military handles its scientists and researchers in terms of mobility and model after that.

8. Develop geographic assignment into a position statement

I. Esprit de corps

1. esprit de corps is not created by uniforms, medal, titles and special ceremonies, but by intensive and shared experience and common mission. (lists examples of peace corps, doc w/o borders, CARE. Conversely lists Queens guard at Buckingham palace – only know in tourists photos and navy seals known for sophisticated special operations).

2. use J. Farrell’s language in the CC bulletin on “why the CC” consider using that in a mini ppt with cameo officers with leadership, PH

J. Clarify what is meant by the #13 rec on state health department assistance

1. Create cross-training opportunities with across OPDIVs, DoD, Other DHHS agencies and States.

2. Can civil servants participate?

3. Provide examples that are not infectious disease focused.

4. How would backfill be handled?

5. Summary from 7/25 BB: no clear benefit. Might work if framed differently – look for other models at cdc (e.g., TB).

6. Is CSTE OK with this?

K. Clarify the role of the proposed CDC Corps leader and emphasis the difference from the OCCO leadership. “the flag officer should be our champion”

L. Awards and ceremonies

1. Highlight CDC’s role in the existing Atlanta-wide promotion ceremony (e.g,. provide facilities)

2. #17 general agreement on the importance of ceremonial celebration – but some disagreement on format (options – leave it up to CIOs, agency wide ceremonies [worry for redundancy and dilution], pair with CS ceremonies). Careful not to “vermilitarize”

3. Add retirement ceremonies to the list

4. Ceremonies should be presided over by lead Flag Officer and CDC Director (or rep)

5. CDC should be more aggressive about putting officers in for awards. Also our awards board should make sure that they are not being stricter than boards at other agencies as this puts CDC officers at a disadvantage.

6. CDC awards board is too strict compared to other agencies. We need to lower the standards to be consistent with others.

7. Awards criteria are not strict enough-awards are handed out for mediocre work.

8. A separate awards ceremony will only further alienate CC from our CS colleagues. We already have a unique promotion ceremony.

9. We have to be careful not to overemphasize awards to the point where people care more about the awards than about the CDC and the public health mission.

M. Can you further clarify the paragraph on new public health capacity?

N. Rec #19 (BOTC)

1. Try to get BOTC before officers report to assignment. Combine BOTC with uniform procurement and training on proper wear. Encourage senior officers to attend BOTC. Be sure that BOTC is NOT scheduled during station leave (i.e., weekends or after hours).

2. BOTC needs to be more available to officers who have been in for a while. The courses need to be announced further in advance instead of the last minute notices for courses in other cities that we get now.

3. Work with CDC corporate university

O. Recommendations 1-4 are great, but only to the extent that the appointees are truly dedicated to the CC. Having high ranking officers and flags who don’t support the CC has always been the problem at CDC and will only weaken the CC.

P. With respect to the wording on the new PH capacity, the sentence that describes the CC as being “at the helm” sounds too self serving and might alienate CS.

Q. Items 2-5 of unique characteristics of the CC don’t seem to be unique to CC or are largely theoretical.

R. The term “prevention” is only mentioned once in the “what is public health section” and that is in the context of research. It needs to be emphasized much more.

S. We should use the CDC’s new 24 goals as a framework for the “what is public health section”.

T. In the conclusion, we should mention that OTPER should work not only with OFRD but also with OCCP.

U. In conclusion change wording to urge SG etc to recognize the impact 3 strikes etc WILL (not might) have on readiness etc.

V. For table 1, we should say that CS are indistinguishable from the general public, not just from other, non-CDC CS.

W. Introduction- why emphasize “clinical”? It’s the least important part of PHS emergency response as clinical expertise exists in abundance elsewhere but our skills do not.

X. The section on “unique characteristics of CO” is simply not current reality. The mission of COs always has been agency based for the most part. Officers in the IHS are not committed to the regulatory mission of FDA, but are deeply committed to their priorities. The discussion of “officership” activities is also a divisive one among CDC Cos. Cos who value real public health achievement and measure their worth based on the true public health impact of what they do are resentful of those Cos who spend their time fulfilling “officership” requirements to get promoted.

Y. 1st line under “new public health capacity” is not clear- needs to be revised.

Z. In esprit de corps section we should push for CCO to attend leadership courses that are offered by other agencies and uniformed services and push for the agency to provide funding so people can go.

AA. Put the 1st group of recommendations at the end to avoid “self-aggrandizing”.

BB. Would revise paragraph 4 to read “efforts focused primarily on clinical issues” and “While some (not many) CCOs maintain clinical proficiency”. 115 hours is not enough and could get our officers into trouble in court cases.

CC. Expand the exec summary to include 22 action one-sentence lines on the recommendations.

DD. Place the comparison of CS and CCO in an appendix as putting it in the paper itself is somewhat distracting.

EE. It seems like it might be insulting to include a section called “what is public health” in a document for the CDC director. Maybe this section should be re-titled to focus more on the CC at CDC.

FF. De-emphasize the section on camaraderie. At CDC camaraderie can (and must, given that we will still be working with CS) be established by working together on public health problems. I disagree strongly that it is strengthened by rank and structure.

GG. I am confused on the section on the role in the future of PH. Why should CCO who work at CDC not have a strong allegiance to CDC? Most of us are very proud of the work we do at CDC. There are already many examples of CCO from different agencies working together- how will the transformation make that better?

HH. The issue of competing allegiances is a tricky one at best- I think we can rework this to avoid having people “choose”. We should review the CC scientific activities that are routine at CDC and identify the ways those activities support the general mission of PHS.

II. The minor issues like visibility and esprit de corps are overemphasized in this document at the expense of discussing some of the real challenges posed by transformation. Consider treating this document as if it were and awards nomination- think about impact and highlight key issues rather than less substantive ones.

JJ. The paper should address the issue that many of the new requirements impose significant administrative responsibilities on officers that require them to take time away from doing the important work of public health to engage in “file buffing”. Again, this will make CCOs less attractive job candidates.

KK. Visibility should come from good work and good leadership- it should not really be a goal in and of itself.

VI. White Paper – Suggested deletions

A. Delete #18 LMI reference – consider moving the generic theme of purposeful leadership training from pirit de corps section to leadership section. Having a group of CCPAC members do LMI might create resentment among other officers as the criteria for selection to CCPAC have never been made clear. Overall not much support because of lack of opportunity, readers didn’t understand what LMI does……….

B. Rework #21 rec to “celebrate” the value of commissioned corps vs. targeting only Civil Servant supervisors (who might delegate this responsibility).

C. The term “militarization” in the conclusion is inflammatory to some officers and should be removed.

D. Could delete table 2 as most of that information is in table 1 already. Perhaps combine the 2.

E. On table 2, would remove the statement that frequent moves broaden overall depth of knowledge. The moves will broaden breadth of knowledge, but likely at the expense of depth.

F. The idea of “joint appointments” should be removed unless there is some evidence that these will provide training value that is relevant to the mission.

G. None of the “unique characteristics” are really unique to CCO.

H. I would delete the conclusion paragraph lines 11-17- it seems out of context and is confusing to me.

VII. MISC Specific recs:

• Diasgree with the empasis the BT aspect of terrorism since it is not the most common form. Also we should put more resources and focus into prevention of terrorism c/w CDC’s mission.

• “do not exclude non-research officers in the various categories (EHO, engineers, HSO, etc) from mention and consideration in the document. These officers must not be ignored they provide as valuable a service as their research counterparts.

• #18 – LMI specification is confusing. Agreement for leadership training across OPDIVS. Need CCO mentorship at CDC.

• #6 – move to Espirit de Corps section

• #22 – overwhelming support for removal of 3 strikes policy due to poor morale; same for 6th precept.

• Not sure if CO-step concept would work for MO at CDC.

• We should vet the paper with a handful of upper level CS CDC employees to see how they feel about what we are saying, especially with respect to the “value added” comments.

• We need to check- I think CS physicians also have to maintain licenses and skills to receive incentives?

• Not sure if the statement about the CC being militarized as part of the Navy is correct-what about other services? Provide the US code/regulation for this statement.

• Need to make sure that CC handles #7 the same way that all other uniformed services do.

• Doesn’t the COSTEP rec contradict the overall theme of the paper? The state purpose of the COSTEP program is to show people the opportunities at CDC. But the paper indicates that agency focus is not good for the PHS. Won’t these young people enter wanting to avail themselves of the opportunities they saw at CDC and won’t they be disappointed when they are told they need to move the IHS to have a career in PHS? This is another indication that the agency loyalty issue should be re-examined.

• #13- I’ve worked in state HD and I don’t think they would agree to the need to be “trained” by CDC. I do support CDC help for state HD in doing their work.

• Table 1: you should acknowledge that CDC (and the world) benefit from having officers with deep knowledge in specific areas. While mobility can be helpful, so is real subject matter expertise.

• Table 1- realistically, CCO really are not distinguishable from CS on skill diversity or depth of knowledge.

• Introduction- 2nd sentence of the 2nd paragraph- should specify who questioned the viability and utility of the CC. Also, the end of the paragraph states to meet these dynamic needs and priorities but does not say what these are.

• Table 2 – keep it simple: this relates to being ready for deployment really

• Unique characteristics of CCO- the statement about CCO serving in levels above their ranks also holds true for CS who must be performing responsibilities of a higher grade before they can be promoted- this should be removed as a difference.

• #13- this should be expanded to include training opportunities for CCO in a variety of venues like WHO, FEMA etc. not just state HDs.

• Page 3, bullet 11- amplify this and maybe even make it #1- maintain scientific expertise.

• A new public health capacity- it’s extraordinary that the word science does not appear in this paragraph.

• Point 14 should be expanded and emphasized.

• Points 13-15 are the most important points in the document but are buried in material that is much less substantive.

• Table 1- would not emphasize militarization.

• Table 2- the “benefits” to CCOs are highly subjective and many can go either way. Encouraged moves could certainly be viewed as a negative by an employer looking for stability as can deployments. The statement that the uniform “automatically instills ideals” is simply not true (and could be viewed as somewhat insulting to CS by implying they are less dedicated because of what they wear). The uniform might also be viewed as a negative by some employers who fear it might create division.

• Pg 6 line 10 – dramatic reduction in # of incoming EISO? Is it true? What is the difference in class 0-4 to 0-5.

• Conclusion: 0-6 should serve as role model. – Discourage mockery of those who do choose to wear uniform daily (e.g., culture)

• Tension exists between CCO and CS. When is it arises in supervisory situations problems develop.

• Paper lacks focus (several scattered messages); unsure of audience. Suggest paper be directed to DHHS policy leadership therefore you can drop PHS history. Primary message of “CCO serve in all health research and practice capacities with more flexibility than CS, and have a wide variety of prevention, intervention and treatment expertise that can be redirected quickly in response to national or global needs” is embedded but gets “lost”.

• Stop reference to militarization! Must refer to national response plan.

• Suggest delete table 2 – doesn’t add much.

• Disincentives for current officers:

• Some of the recs seem to run counter to rec #1 regarding recruiting and retaining more CC officers. In particular wearing the uniform every day is a disincentive to joining/staying, not an incentive. So too is making the corps member more deployable to duties unrelated to what their current supervisor thinks he hired them to do. This won’t win plaudits from the supervisor and other leadership (no matter what song they might sing when certain ears are listening). You might want to separate recommendations by whether durrent or prospective Corps members would like them or whether they were added because HHS expects us to get in line. Seems some of what you are doing is at cross purposes to your stated intent.

• I don’t like the white paper. People are leaving and taking all the hard earned PH experience with them. I don’t see how this WP helps. Points I disagree with or feel need further clarification are as follows:

• #1 – the decision should be solely based on professional qualifications. This rec would engender ill feelings from CS employees.

• #6 I would say that the HRSA rule is adequate: Wednesday plus one. Give option to gain points on COER

• Disappointing to read:

• Lot of work but message is not clear or precise.

 

Last Reviewed: December 8, 2005