Physician Assistants Employed by the Federal Government.

OBJECTIVE: Physician assistants (PAs) are health professionals who have received advance medical training and are licensed to diagnose illness, develop and manage treatment plans, prescribe medications, and serve as principal health care provider. Although the U.S. federal government is the largest single employer of PAs, at the same time little is known about them across the wide array of diverse settings and agencies. The objective of this project was to determine the census of PAs in federal employment, their location, and personal characteristics. This included approximating the number of uniformed PAs. Taking stock of a unique labor force sets the stage for more granular analyses of how and where PAs are utilized and are deployed. METHODS: No one central database identifies all federally employed PAs. To undertake this project, three sources were examined. Data were derived from the U.S. Office of Personnel Management and the National Commission on Certification of Physician Assistants. Uniformed PA numbers were the result of networking with senior chiefs in the military services and the U.S. Public Health Service. The data were collolated and summarized for comparison and discussion. RESULTS: As of 2018, approximately 5,200 PAs were dispersed in most branches and agencies of the government that provide health care services, including the Departments of Defense, Veterans Affairs, Health and Human Services, Justice, and Homeland Security. Federally employed PAs are civil servants or hold a commission in the uniformed services (ie, Army, Navy, Air Force, Coast Guard, and Public Health Service). Most PAs are in clinical roles, although a few hundred are in management positions. Approximately 81% of civilian PAs have had less than 15 years of federal employment. CONCLUSION: The diverse utilization and deployment of PAs validate the importance of the role they serve as medical professionals in the federal government. From 2008 to 2019, PA employment in the federal government grew by approximately 50% supporting the forecast that substantial national PA growth is on track.

New chapter in NCFE saga. SEC's civil fraud charges against executives at failed firm offer cold comfort for the hospitals, physicians hurt by the debacle.

Trouble revisited National Century Financial Enterprises last month, when the Securities and Exchange Commission sued four former execs for the accounting fraud that caused the financial firm's collapse in 2002. The investigation worries some, but others, like Kathy Patrick, left, an attorney representing former NCFE investors, says there is "legitimate business to be done in the purchase of healthcare receivables."

The Department of Defense pharmacy benefit management program.

Prescription drug prices are frequently both politically and personally salient issues. The Department of Defense (DoD) offers a robust prescription benefit to 8.8 million beneficiaries. This benefit has evolved to meet changes in technology and patient requirements. The PharmacoEconomic Center (PEC) was established as the first pharmacy benefit manager entity in 1992, primarily in response to rapidly rising DoD pharmacy program expenditures. In its short history, the PEC has dramatically improved patient safety and decreased costs. To accelerate the efficiency and effectiveness the enterprise-wide pharmacy benefit manager has already achieved, DoD should increase the funding, staff, and authority of the PEC.

The Results Act: a challenging management framework.

This article provides the reader with a basic understanding of the Government Performance and Results Act of 1993. The Act requires federal agencies to institute a planning and reporting management framework to achieve results. It also identifies challenges federal agencies face in implementing a stronger results management approach and promising practices agencies can use in crafting their management approach.

A strategic approach to public health workforce development and capacity building.

In February 2010, CDC's National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention (NCHHSTP) formally institutionalized workforce development and capacity building (WDCB) as one of six overarching goals in its 2010-2015 Strategic Plan. Annually, workforce team members finalize an action plan that lays the foundation for programs to be implemented for NCHHSTP's workforce that year. This paper describes selected WDCB programs implemented by NCHHSTP during the last 4 years in the three strategic goal areas: (1) attracting, recruiting, and retaining a diverse and sustainable workforce; (2) providing staff with development opportunities to ensure the effective and innovative delivery of NCHHSTP programs; and (3) continuously recognizing performance and achievements of staff and creating an atmosphere that promotes a healthy work-life balance. Programs have included but are not limited to an Ambassador Program for new hires, career development training for all staff, leadership and coaching for mid-level managers, and a Laboratory Workforce Development Initiative for laboratory scientists. Additionally, the paper discusses three overarching areas-employee communication, evaluation and continuous review to guide program development, and the implementation of key organizational and leadership structures to ensure accountability and continuity of programs. Since 2010, many lessons have been learned regarding strategic approaches to scaling up organization-wide public health workforce development and capacity building. Perhaps the most important is the value of ensuring the high-level strategic prioritization of this issue, demonstrating to staff and partners the importance of this imperative in achieving NCHHSTP's mission.

Enumeration of the governmental public health workforce, 2014.

BACKGROUND: Regular assessment of the size and composition of the U.S. public health workforce has been a challenge for decades. Previous enumeration efforts estimated 450,000 public health workers in governmental and voluntary agencies in 2000, and 326,602 governmental public health workers in 2012, although differences in enumeration methodology and the definitions of public health worker between the two make comparisons problematic. PURPOSE: To estimate the size of the governmental public health workforce in 14 occupational classifications recommended for categorizing public health workers. METHODS: Six data sources were used to develop enumeration estimates: five for state and local public health workers and one for the federal public health workforce. Statistical adjustments were made to address missing data, overcounting, and duplicate counting of workers across surveys. Data were collected for 2010-2013; analyses were conducted in 2014. RESULTS: The multiple data sources yielded an estimate of 290,988 (range=231,464-341,053) public health workers in governmental agencies, 50%, 30%, and 20% of whom provide services in local, state, and federal public health settings, respectively. Administrative or clerical personnel (19%) represent the largest group of workers, followed by public health nurses (16%); environmental health workers (8%); public health managers (6%); and laboratory workers (5%). CONCLUSIONS: Using multiple data sources for public health workforce enumeration potentially improves accuracy of estimates but also adds methodologic complexity. Improvement of data sources and development of a standardized study methodology is needed for continuous monitoring of public health workforce size and composition.

Understanding the local public health workforce: labels versus substance.

BACKGROUND: The workforce is a key component of the nation's public health (PH) infrastructure, but little is known about the skills of local health department (LHD) workers to guide policy and planning. PURPOSE: To profile a sample of LHD workers using classification schemes for PH work (the substance of what is done) and PH job titles (the labeling of what is done) to determine if work content is consistent with job classifications. METHODS: A secondary analysis was conducted on data collected from 2,734 employees from 19 LHDs using a taxonomy of 151 essential tasks performed, knowledge possessed, and resources available. Each employee was classified by job title using a schema developed by PH experts. The inter-rater agreement was calculated within job classes and congruence on tasks, knowledge, and resources for five exemplar classes was examined. RESULTS: The average response rate was 89%. Overall, workers exhibited moderate agreement on tasks and poor agreement on knowledge and resources. Job classes with higher agreement included agency directors and community workers; those with lower agreement were mid-level managers such as program directors. CONCLUSIONS: Findings suggest that local PH workers within a job class perform similar tasks but vary in training and access to resources. Job classes that are specific and focused have higher agreement whereas job classes that perform in many roles show less agreement. The PH worker classification may not match employees' skill sets or how LHDs allocate resources, which may be a contributor to unexplained fluctuation in public health system performance.

Public health workforce taxonomy.

Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012-2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection.

Changes in public health workforce composition: proportion of part-time workforce and its correlates, 2008-2013.

BACKGROUND: State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. PURPOSE: To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. METHODS: We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. RESULTS: Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. CONCLUSIONS: This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing.

The Global Health Initiative and the health workforce.

The United States Government (USG) strategy for global health is embodied in the Global Health Initiative (GHI), announced by President Obama in 2009. The GHI addresses the array of US global health programs and concerns. There is laudable recognition of the health workforce crisis as a major barrier to achieving the Millennium Development Goals and the USG's global health goals. Significant funding is provided to train health workers and conduct other activities that may be seen as addressing the health workforce crisis. Unfortunately, the USG approach to the health workforce is not guided by a coherent strategy. In sharp contrast to its approach to more traditional, disease-specific programs, the GHI fails to articulate objectives, technical approach, metrics, organization, staffing or resource allocation with regard to the health workforce. The result is a series of projects unguided by any framework. The article outlines a health workforce strategy for the GHI. It proposes objectives, a technical approach, key indicators of progress, structural reforms and resource requirements.