Federal physicians and dentists are employed under numerous statutory authorities. However, the great majority--over 97%--again are found in only three The uniformed services personnel system 70% of HFW physicians and all but a small percentage of HEW dentists are in Commissioned Corps (CC), a fourth uniformed . The VA Department of Medicine and Surgery The General Schedule (GS) system (the familiar The basic principle linking pay of civilian Federal employees to pay in the private sector is that Federal pay should be comparable to that obtained by employees in the private sector performing the same level of work. For white collar civilian employees, comparability is maintained through an annual survey conducted by the Bureau of Labor Statistics that ascertains private enterprise pay rates for jobs with work levels equivalent to those covered by the General Schedule. GS pay rates are adjusted accordingly each October, and the pay rates in the other two personnel systems under which the Federal Government employs large numbers of physicians and dentists -- the VA and uniformed services systems are adjusted simultaneously according to linkages established by statute. Federally employed physicians and dentists generally receive increments of pay over and above the levels pro These added vided through the comparability process. increments of pay are provided to permit agencies to meet their requirements for physicians and dentists in competition with other employment opportunities. The need to minimize deviation from the basic comparable Federal pay scales in order to preserve equity among employees and fiscal prudence both dictate that to the extent pay above general Federal pay scales is needed to attract members of particular occupational groups in the number and quality needed by Federal agencies, that extra pay should be the minimum necessary to obtain the numbers and quality of personnel needed. Various methods are used to provide physicians and dentists compensation above that provided to other professionals in the same personnel system with similar training and experience. These methods include explicit bonuses, special pay tables, and favorable ranking or grading procedures. Through one or another of these methods, and frequently through a combination of them, higher compensation is received by physicians in all three personnel systems and by dentists in the VA and uniformed services system (but not by GS dentists). Appendix I includes more detailed information on the numbers of Federal physicians and dentists, their activities in the agencies that employ them, and the statutory authorities under which they are employed. This appendix also outlines problems in recruitment and retention of physicians cited by agencies that employ these professionals in relatively small numbers. I-C. Income Comparisons P.L. 94-123, which mandates this report, requires that it contain a comparison of remuneration of federallyemployed physicians and dentists with income of those in the private sector (both in private practice and in academic positions). Appendix II provides that comparison in detail; this section summarizes the comparison. As noted above, most Federal physicians and dentists are not compensated under the comparability principle, but receive additional compensation under a competitiveness approach. Under this approach, the adequacy of compensation for federally employed physicians and dentists must be judged not on the basis of comparisons in this section, but on the basis of findings in Chapters III to VI on how readily Federal agencies meet their physician and dentist staffing needs. A comparison of remuneration ideally would include all components of compensation. Because of limited information, the comparisons presented here include only current money income and provisions for retirement. Provisions for retirement are often omitted from comparisons, but form an important component of compensation, particularly for Federal employees. Private incomes vary widely, depending upon several variables including workload, specialty, region, urban or rural location, age, and practice arrangement (solo, partnership, group). Federal incomes, in contrast, are related largely to age and position responsibilities. Hence income data has been developed separately for each age group. The first chart shows income -- including provisions for retirement for private, office-based physicians, and for four groups of Federal physicians.* It should be noted that the "private, office-based" category excludes not only physicians in training, but also other substantial categories (for example, researchers and government employees) with, generally, relatively low incomes. overall physician incomes are somewhat lower. Hence, Private, office-based physicians' incomes rise relatively steeply in the first years of practice, are relatively flat at about $70 thousand through much of a doctor's working life, and then fall in later years as workload is reduced. Federal physicians' incomes are generally substantially lower, with provisions for retirement comprising a larger portion of the total. Peaks range from about $45 thousand for GS physicians to nearly $70 thousand for uniformed services physicians. The compensation of GS and VA physicians changes relatively little with age; that of uniformed services physicians increases sharply up to ages in the late 40s. Compensation of teaching physicians is substantially lower than income of private practice physicians; approximately $50 thousand is the median income for full professors, the highest rank to which most academic physicians can aspire. The second chart shows dentists' incomes, again with retirement provisions included. In the private sector, In this chart, as throughout this study, Federal compensation levels in effect from October 1975 to October 1976 are reported. |