Uncle Sam wants you for disaster response team

Washington -- When it comes to preparing the nation for natural disasters and other public health emergencies, the federal government is looking for a few good physicians.

The Dept. of Health and Human Services recently announced its plan to modernize the U.S. Public Health Service Commissioned Corps, one of the nation's seven uniformed services. When the transformation is completed, the group of physicians, nurses, pharmacists and other health professionals will become a more integral part of the government's emergency response network.

"Our officers treat disease, ensure the safety of food and medicine, and restore health and hope in times of greatest need," said Surgeon General Richard H. Carmona, MD, MPH. "Increasing the number of Commissioned Corps officers and restructuring the deployment process will make us more agile and efficient while continuing to fulfill our daily mission."

As a first step, the Bush administration aims to add 600 officers to the current roster of 6,000. The White House also hopes to make the group more efficient by better arranging physicians and other officers according to medical specialty, improving the process that assigns officers to disaster areas and recruiting new members according to medical needs.

The final goal is to bring about the re-emergence of the Commissioned Corps, which has existed since 1798, as a major player in the public health system, said HHS Secretary Michael Leavitt. When officers are not responding to natural disasters, disease outbreaks or terrorist attacks, they often are assigned to fill holes in underserved areas.

"I see a U.S. Public Health Service Commissioned Corps that's bigger, that's better trained, that's organized for a uniquely 21st-century mission and that's, frankly, better known," he said.

Inspired by hurricane response

While a plan to overhaul the Commissioned Corps was proposed during the tenure of former HHS chief Tommy Thompson, the department did not proceed past the planning stage. But when Leavitt saw some of the more than 2,000 officers who deployed to staff field hospitals and emergency medical clinics in areas devastated by last year's hurricanes, he became determined to finish the job.

Physicians who are interested in joining the more than 1,300 doctors who are already enlisted in the service must be U.S. citizens younger than age 44 who have served less than eight years in any of the other uniformed services. Candidates must have an accredited doctor of medicine or doctor of osteopathy degree, meet certain fitness requirements and pass a basic training course.

Once they are accepted, doctors are usually assigned as a salaried federal worker at an agency that partners with the Commissioned Corps, such as the Centers for Disease Control & Prevention, the Indian Health Service or the National Institutes of Health. Officers need to be willing to depart quickly to address public health emergencies that can be difficult and dangerous, though Leavitt stressed that such assignments are always temporary.

The overhaul plan has had its detractors. When several details of the transformation were first proposed in 2003, then-FDA Commissioner Mark McClellan, MD, PhD, said some changes would disrupt the service. Tougher physical fitness exams and more stringent deployment readiness requirements for officers could cause many qualified people to drop out or decide against applying, he said at the time. The new fitness and readiness rules have been adopted, but some exemptions were established for officers serving in administrative capacities.

Some congressional Democrats also took issue with the plan to move the primary responsibility of running the Commissioned Corps away from the surgeon general and into the office of the HHS assistant secretary for health, traditionally a more political appointment.

At the event announcing the reforms, Leavitt swore in John Agwunobi, MD, a pediatrician and former state health secretary in Florida, as an assistant secretary for health and the highest-ranking officer in the service.