There's a little-known secret about the Public Health Service (PHS): its Commissioned Corps is one of the seven uniformed service that protect the United States. But unlike the Army, Navy, Air Force, Marine Corps, Coast Guard, and National Oceanic and Atmospheric Administration Commissioned Officer Corps, the PHS Commissioned Corps' all officer organization is composed entirely of health professionals who, thought unarmed, fight an often elusive enemy.
For more than a century, men and women of the PHS Commissioned Corps have served on the front lines of the nation's health defenses, alongside their military counterparts, safeguarding a fundamental aspect of national security--the public health. Commissioned Corps officers regularly participate in international relief efforts as well, having battled everything from infectious diseases such as smallpox through massive vaccination campaigns, to infant mortality on Indian reservations through the education of expectant mothers. Officers recently have assisted in developing a new health care system in Afghanistan.
Today, Corps officers from eight PHS agencies, including the Food and Drug Administration, are battling AIDS, cancer, drug abuse, product tampering, and other health issues requiring specialized skills. This kind of combat requires officers to use their professional training in medicine, dentistry, sanitation, social work, and other health disciplines in the fight to promote good health and minimize disease and suffering.
"Some of the best people we have today in FDA are in the Corps," says Acting FDA Commissioner Dr. Lester M. Crawford. In addition to ensuring safe and effective drugs and medical devices and educating the public about health matters from their offices at FDA headquarters, this medical militia is ready to respond to public health needs anywhere in the United States or around the world in times of war or other emergency.
"Deploying members of the Corps was a big part of what the Department of Health and Human Services and the FDA contributed to the aftermath of 9/11," Crawford says.
Building on Tradition
The PHS can trace its origins back to 1798, when Congress passed an act to provide for the care and relief of sick, destitute merchant seamen. The result of the act was a network of hospitals that eventually came to be known as the Marine Hospital Service. In 1870, the service was reorganized with its headquarters in Washington, D.C., and the following year the first Supervising Surgeon--now called the Surgeon General of the United States--was appointed.
In 1889, Congress established the Commissioned Corps to ease health care personnel shortages in the nation's hospitals. Officers were commissioned as a nonmilitary service with a distinct uniform and insignia, and with titles, pay, and retirement systems that corresponded to those of the military services. Eventually, members of the Commissioned Corps became a mobile force of health professionals subject to reassignment in order to meet the needs of the PHS.
Originally, the Corps was composed only of physicians. Over the years, as the functional responsibilities of the PHS and the Corps have broadened, so has the range of health professions represented. In addition to medical doctors, the PHS currently commissions 10 other categories of health professionals: pharmacists, dentists, nurses, engineers, scientists, veterinarians, environmental health officers, dietitians, therapists, and health service officers. The health service officer category includes social workers, optometrists, computer scientists, and medical records administrators.
The responsibilities of the service expanded in the late 19th century to include public health measures such as quarantine and the medical inspection of immigrants. The Marine Hospital Service became the Public Health and Marine Hospital Service in 1902, and a decade later, the name was changed to the Public Health Service. With the expansion of its public health activities throughout the 20th century, the PHS today is a principal part of the Department of Health and Human Services (HHS) and a major health agency within the federal government.
Currently commanded by Vice Adm. Richard H. Carmona, M.D., M.P.H., surgeon general of the United States, the Commissioned Corps is an elite group of expert, diverse, and flexible public health professionals who can respond quickly, on the surgeon general's activation, to both immediate and long-term health needs. Some of those needs include increasing preparedness for public health emergencies, reducing health disparities, and developing strategies to prevent or reduce the incidence of chronic diseases.
Their uniforms and their readiness for immediate deployment are what set Commissioned Corps officers apart from the other doctors, nurses, dieticians, and scientists who are their civil service counterparts at the FDA and other PHS agencies.
Drawing on the expertise of PHS officers like Rear Adm. Marlene E. Haffner, M.D., M.P.H., an assistant surgeon general and director of the FDNs Office of Orphan Products Development, Carmona says, "I rely on the breadth and depth of experts like Marlene. And, no matter what issue confronts me," he adds, "I can pick up the phone at any time and talk to the world leaders in public health."
Rear Adm. Steven K. Galson, M.D., M.P.H., an assistant surgeon general and acting director for the FDA's Center for Drug Evaluation and Research, says that the Commissioned Corps, for him, has been "a great career developer." The beauty of the Corps, Galson says, is that it has enabled him to move from job to job over the years "on one piece of paper"--indicating the ease with which an officer can transfer. "You're considered to be a stronger officer if you've had a lot of mobility," he says.
The choice to enter the Commissioned Corps instead of the civil service system depends on a number of factors, including type of assignment, needs of the program in which the assignment is located, and a health professional's personal interest and desires, training, and experience. All told, the PHS has about 6,000 Commissioned Corps officers and 51,000 civil service employees.
Rear Adm. Mary Pat Couig, chief professional officer for the nursing category and also an assistant surgeon general, advises Commissioned Corps candidates to "make sure that the Corps explains the expectations of being an officer in a uniformed service, and that it is a good fit." Potential officers, she says, "need to be willing to accept response-readiness," a now-mandatory requirement for Corps members to be trained and then available to act on a moment's notice. Couig is assigned to the FDA's Office of Orphan Products Development.
About 700 of the FDA's 10,000 employees wear the PHS Commissioned Corps uniform, continuing the long tradition of promoting the public health in the United States. Officers today wear uniforms that closely resemble those of the Navy--but with a unique Corps insignia--and hold rank similar to that of naval officers, such as lieutenant, commander, captain, and admiral.
Ready to Respond
In July 2003, the HHS embarked on an ambitious, ongoing process that Secretary Tommy G. Thompson called "the biggest and most sweeping transformation in the history of the Corps." Anticipating that Corps members would be needed to respond to the challenges of the 21st century, Thompson said the plan includes scholarships to recruit as many as 1,000 nurses and 100 doctors per year to work in medically underserved areas. Additional short-term duty missions to address presidential and HHS initiatives, such as childhood immunizations, diabetes detection, terrorist attacks, and the recruitment of several hundred new officers to support the Indian Health Service, also are part of the plan.
The transformation phases out the former Commissioned Corps Readiness Force structure that consisted of mostly voluntary deployments, and replaces it with a revised system designed to bring the status of the Commissioned Corps to a mandatory 100 percent deployability by the end of 2005.
"As we stare into an uncertain future of possible terrorist attacks, natural disasters, and emerging infectious diseases, the president and the American people must know they can depend on their Public Health Service to aid them in times of need," Thompson says. And they will be ready to act on a moment's notice. Thompson also stated that no one is better suited to respond to such needs than the officers of the Commissioned Corps. "The Corps has always been able to adapt to the urgent needs of each generation."
