Calculated Conversion

Jan. 1, 2005

Next Oct. 1, if all goes as planned, the Air Force will begin to execute a three-year program that will convert more than 2,000 uniformed medical jobs to federal civilian or private contract positions.

The conversions, set to occur in Fiscal 2006, 2007, and 2008, are part of a Pentagon-wide “transformation” initiative that would drop from the rolls thousands of uniformed medical personnel now ensconced in base hospitals and clinics.

These military members would be replaced with less expensive civilian medical staff.

The goals are twofold. One is to hold down the Air Force’s rising health care costs. The second is to increase the number of uniformed combat forces by shifting precious authorized positions out of support functions and into operational functions, all without increasing USAF end strength.

The Air Force estimates that its medical job shift, when fully implemented, will save the service $33 million a year, with no impact on the quality of health care or patient access to medical services. More importantly, the Air and Space Expeditionary Force will expand by some 2,000 members.

Maj. David Berthe, a medical programmer for the Air Force surgeon general, said plans call for converting some five percent of the service’s nearly 40,000 uniformed medical staff jobs.

The program will convert 400 jobs in Fiscal 2006 and about 800 positions in each of the next two years. The exact number of targeted positions is 2,029.

Fewer Blue Suits

“This should not impact our beneficiaries,” said Berthe. “What they will notice are fewer blue suits in a facility and more white collars, but the intent is a one-to-one trade-off, replacing a blue suit … with a civilian equivalent.”

The move, Berthe went on, will allow the Air Force “to restructure the force, to shift more assets from support positions—medical being considered a support position—to warfighting positions without increasing the military’s end strength.”

Of the jobs slated for conversion, about 400 are positions for officers, mostly nurses. The number of Air Force uniformed physicians and dentists will not change.

By contrast, the Navy expects to civilianize more than 150 family physician positions in its first round of conversions to begin next July.

The 1,600 Air Force enlisted jobs targeted for conversion are engaged in a wide range of technical specialties, supporting pharmacies, dental clinics, optometry, diet therapy, and medical laboratories.

No involuntary separations from service will occur, said Berthe. “Normal attrition over the various career fields will enable us to accommodate these” conversions, he said.

The medical staff shifts result from a joint service study ordered by the Defense Department’s director of program analysis and evaluation. In a series of weekly meetings that kicked off last February, service medical staffs and PA&E officials reviewed which medical billets had no readiness mission and therefore could be performed by civilians.

The Navy identified 5,400 positions out of 41,000 military medical personnel. Its conversions are scheduled to run through 2011.

To cover the last three months of Fiscal 2005, the Navy requested $35.8 million to add 1,772 civilian medical workers to its payroll. That’s an average cost of $20,000 per new employee for the July-through-September quarter, or about $80,000 per position annually.

Details of the Army’s military-to-civilian conversion initiative were not available. Virginia Stephanakis, spokeswoman for Army Medical Command, said it, too, will free up more military jobs for warfighting units without degrading quality of care or access to care 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.

Lt. Cmdr. Tim Weber, head of manpower operations for the Navy’s Bureau of Medicine, agreed that any decision to convert a medical billet must depend on the availability of a qualified and affordable replacement.

Conversion—Not a Cut

“We are absolutely not changing the quality of care,” said Weber. “We are solely changing the color of the uniform. This is a conversion; this is not a cut.”

The medical job conversions are only part of a larger Defense Department effort to civilianize as many military billets as possible, both to hold down personnel costs and to make more effective use of uniformed personnel.

During 2004 and 2005 combined, officials said, DOD-wide conversions would total about 20,000.

In October, David S.C. Chu, the undersecretary of defense for personnel and readiness, told the annual meeting of the Association of the United States Army that “a significant degree of rebalancing is necessary” across the Pentagon’s entire workforce of 2.7 million active and reserve members, 650,000 federal civilians, and 96,000 nonappropriated fund employees.

DOD wants to convert up to 300,000 military billets to civilian positions, Chu said. The Pentagon is evaluating whether it can and should do so.

The conversion process will be helped, Chu suggested, by Congressional approval last year of the National Security Personnel System, the Bush Administration initiative to overhaul the way civilian personnel are managed.

The department will be able to shape a “more responsive and flexible” workforce, Chu said, using new tools to hire, reward, and fire employees. The revised pay system will emphasize performance over longevity.

Regulations are being drafted, Chu advised, and the NSPS should be implemented in full by 2008.

The medical job conversions, Weber said, will give commands an opportunity to reorganize and to become more efficient.

For example, he said, a hospital that has 10 enlisted administrative positions marked for conversion may decide to hire only five civilian replacements but also three transcription specialists who could lighten the paperwork load on all of its physicians.

Decisions about whether uniformed medical members should be replaced by federal civilians or contract employees will be made by regional Air Force commanders, Berthe said.

The deliberate pace of the conversions—2,000 over three years—should allow time “to implement this in a smart fashion,” he said, “so we take into consideration local job markets and … don’t in any way hamper access to care for the beneficiaries.”

In deciding what jobs to convert, Berthe said, officials took account of rotation requirements. More jobs could be filled by civilians, but there must be some nonreadiness slots for uniformed personnel to return to after particularly high-stress front-line operational tours.

“We strictly focused our analysis on those billets that were over and above that readiness requirement,” he said.

Replacing military personnel with civilians saves money, Berthe said, because civilian hires don’t need to be trained in their health care specialties. Also, civilian employees cover more of the cost of their retirement, health care, and other benefits.

“We expect to be able to hire a diet therapy technician far less expensively than we could bring one into the Air Force, put him or her in a blue suit, insure him or her with the Tricare health care benefit, and then, if the person were to stay 20 years, pay that retirement annuity,” Berthe said.

Physicians Untouched

The Air Force decided it would not be cost-effective, however, to convert any physician or dentist positions, he said, because they “are so incredibly expensive to contract for, or even to hire as General Schedule government employees.”

Though the Navy will convert 13 percent of its military medical jobs—more than two-and-a-half times what the Air Force plans to convert—Berthe dismissed the notion that his service was less aggressive in carrying out the DOD mandate.

“The services came in having already defined what we knew we needed to meet our readiness requirement,” he said. “This study just looked at the difference between what we know we needed for that readiness platform and what we had in the inventory.”

That the Navy is converting more jobs than the Air Force, he said, “simply means … they had more in their inventory” in excess of readiness requirements.

Besides saving tax dollars, medical job conversions could improve patient access to care, Berthe suggested.

He noted how military personnel get tapped on occasion for special details, readiness training, or deployments that take them away from hospitals and clinics. Civilian medical personnel don’t face those types of collateral duties. Nor are they ordered every few years to leave jobs they know well in order to take on new assignments.

The Air Force is committed to protecting patient services, Berthe said, while “sort of recoloring the uniforms.”

Tom Philpott is a contributing editor of Air Force Magazine. He is the editor of “Military Update” and lives in the Washington, D.C., area. His most recent article for Air Force Magazine was “Total Force Tricare,” in the April 2004 issue.