Title 38 Hybrid Physicians and Dentists Pay Plan PDPP

1. Title 38 Hybrid Physicians and DentistsPay Plan (PDPP) Steve Griffitts BUMED M1 September 23, 2009

2. 2 Purpose The purpose of the DoD Title 38 PDPP is to establish a competitive and market-sensitive compensation system for Federal civilian physicians and dentists under the General Schedule (GS) who did not convert to NSPS due to collective bargaining agreement coverage. The PDPP helps ensure internal equity with their NSPS counterparts by applying the Veterans� Affairs physician and dentist pay model, which was also the model for NSPS.

3. 3 Applicability Applies to all GS physicians (0602) and dentists (0680) covered by a CBA Covered physicians and dentists retain base pay structure of GS Market pay additive, under Title 38, based on specialty, level of work, and market factors

4. 4 Implementation Timeline(Notional) Sep 09 DoD-level training for collective bargaining agreement teams Oct-Dec 09 Collective Bargaining with local unions at activity or region Jan-Mar 10 Revisions of implementing guidance based on CBA Jan-Mar 10 Training for managers and employee Mar-Jun 10 Notional implementation period

5. 5 GS Physicians & Dentists: Where They Are

6. 6 Governance: Joint Compensation Panels At least one representative from each service (Army, Navy, Air Force) Chartered to serve in regions where more than one component medical activity exists Ensures internal equity and consistency among regional activities Provide oversight for Activity Compensation Panels in that area

7. 7 Governance: Activity Compensation Panels Membership - at least one physician and one dentist not holding management position (preferred) Includes HR specialist and Administrator Recommend pay setting for new hires, reassignments, promotions Recommends Tier assignment and market pay for each physician and dentist At least annually conducts salary analysis and make market pay adjustment recommendations, as necessary Forward recommendations to the Authorized Management Official (AMO) for final approval

8. 8 Governance: Authorized Management Official Activity level, appointed in writing, no lower than two levels below head of activity (subject to change if DoDI requires higher level) Approves Tier assignment and market pay for each physician and dentist new hire, promotion, reassignment, or pay adjustment Coordinates with the Health Professions Civilian Compensation Standing Committee when recommended pay exceeds Tier maximum

9. 9 Conversion Process: GS to PDPP Similar to NSPS conversion process for physicians and dentists� �No one will lose pay� Conversion Worksheet Base pay remains established GS grade/step Physicians Comparability Allowance (PCA), Premium Pay, and Locality Pay or Special Rate Supplement, recalculated as PDPP Market Pay Base Pay + Market Pay = New Total Annual Salary (TAS)

10. 10 Conversion Process: Example Emergency Medicine Physician GS-0602-15, Step 10 (RUS Locality) Base pay: $127,604 Locality Pay (RUS): $17,686 PCA: $14,000 Annual O/T (2 hrs wk): $5,000 Total Market Pay: $36,686 Total Annual Salary (TAS) (Base $127,604 + Market $36,686) = $164,290

11. 11 Conversion Process (cont�d) AMO will adjust salary of physician or dentist to ensure that TAS is no less than minimum of Tier AMO will also adjust salary of physician/dentist on grade or pay retention to Step 10 to ensure excess salary is added to market pay Premium pay adjustment will be determined by the activity AMO based on premium pay earned or anticipated and annualized for conversion As with the VA pay and NSPS, premium pay (other than for religious observances) not authorized for physicians and dentists under the PDPP

12. 12 PDPP Pay Architecture VA model: pay banding system comprised of a base salary supplemented with market pay Base pay - General Schedule Market Pay - Based on: Table: Specialties categorized (by VA) into 5 tables Tier: Four Tiers per table. Each tier is a broad pay band with minimum and maximum pay ranges. Tier levels based on type of facility and complexity of practice (not specialty) Market pay set on established internal & external criteria TAS (base + market) may not exceed Tier maximum for specific specialty.*

13. 13 PDPP Pay Architecture: Table Assignment Examples* Table 1 Family Practice Pediatrics Internal Medicine Psychiatry Neurology Preventive Medicine Dentists (except O/S) Table 2 Emergency Medicine Occupational Medicine Physical Rehab Medicine OB/GYN Hematology/Oncology Table 3 Dermatology Gastroenterology Oral Surgery Table 4 Radiology Urology General Surgery Anesthesiology Table 5 Orthopedic Surgery Interventional radiology Cardiovascular surgery Neurosurgery

14. 14 PDPP Pay Architecture: Tiers 1 & 2 Ranges Table 1 Tier 1: $ 91,530 - $175,000 Tier 2: $110,000 - $200,000 Table 2 Tier 1: $ 91,530 - $200,000 Tier 2: $115,000 - $215,000 Table 3 Tier 1: $ 91,530 - $245,000 Tier 2: $120,000 - $265,000 Table 4 Tier 1: $ 91,530 � $270,000 Tier 2: $125,000 - $285,000 Table 5 Tier 1: $ 91,530 - $320,000 Tier 2: $140,000 - $350,000

15. 15 PDPP Pay Architecture: Tier Definitions The following provide a general overview definition. The complete definitions can be found in the b/up slides. Tier 1: Nonsupervisory, direct care, clinic, dispensary or ambulatory treatment facility Tier 2: Direct care, program managers, supervisors at Tier 1 & 2 level activities, full-service treatment facility Tier 3: Direct care, program managers, researchers, medical centers, research activities Tier 4: Component or DoD-wide specialty expert, specialty program manager or nationally recognized researcher, typically headquarters or research activity

16. 16 Pay Administration Those under PDPP are also eligible for: Recruitment, relocation, and retention incentives Student Loan Repayment Program Chapter 45 Awards Within grade increases Quality Step Increases

17. 17 Pay Administration Those under PDPP are ineligible for: Physician�s Comparability Allowance Premium pay ( except for compensatory time off for religious observances) Grade and pay retention

18. 18 Pay Setting: New Hires General steps: Hiring manager (HM) selects candidate off Certificate of Eligibles or through Direct Hire process. HM obtains salary information, work experience, qualifications, etc from candidate to begin Pay Setting Worksheet (PSW). ACP convenes, either based on set schedule, or as needed. Panel Administrator ensures ACP has all necessary data. HM will be �ad hoc� to support his/her new hire. Presents PSW and target salary proposal for consideration.

19. 19 Pay Setting: New Hires (cont�d) ACP will review PD and validate GS grade and step level in accordance with established criteria. Generally, GS-14/15 physicians, GS-13/14 dentists (under current OPM standards). ACP may consider �Superior Qualifications� based on 5 CFR criteria and activity philosophy. May establish up to step 10 without HRO approval.

20. 20 Pay Setting: New Hires (cont�d) ACP determines Tier assignment, based on established criteria. (Tier definitions and assignment criteria are in backup slides). Tier determines pay range to target market pay to calculate proposed TAS. Although Tier level may already be established for the position being filled, it should always be reviewed and validated.

21. 21 Pay Setting: New Hires (cont�d) Market Pay � Determining market pay is most important responsibility of ACP in pay setting process. As long as TAS does not exceed Tier maximum (with exceptions) ACP has flexibility in setting market pay. ACP will evaluate a variety of criteria, including additional guidance from HPCCSC and Regional Compensation Panel (if applicable). Overarching goal to balance internal & external equity.

22. 22 Pay Setting: New Hires (cont�d) The ACP will consider the following seven established criteria when determining market pay: - Level of experience in specialty - Health care labor market forces - Board certification - Accomplishments and awards and recognitions - Other unique qualifications and credentials - Adherence to merit system principles - HPCCSC guidance

23. 23 Pay Setting: New Hires (cont�d) HM may request exception to exceed Tier maximum, with strong, written justification. Such justification must be based on the premise that failure to approve the exception would significantly impair the activity�s ability to recruit or retain well-qualified physicians or dentists.

24. 24 Pay Setting: New Hires (cont�d) The ACP will complete the PSW and then forward to the AMO for approval. The AMO will review the PSW and any attached documentation and take one of the following actions: Approve the recommendation of the ACP Forward to HPCCSC for concurrence if exception to Tier maximum recommended Non-concur with ACP and submit alternative proposal If ACP non-concurs with AMO proposal both proposals are forwarded to the HPCCSC for final decision

25. 25 Pay Setting: New Hires (cont�d) Once HM has an approved salary, completed and signed PSW, he/she will contact selectee and present offer. If candidate agrees with offer, PSW and RPA will be submitted to HR Service Center. If candidate does not accept initial offer, HM has option to consider an alternate candidate or propose a revised offer to ACP, which will initiate pay setting process all over again. Revised offer may include either increased market pay (increase in TAS) or an incentive.

26. Questions?

27. BACKUP SLIDES

28. 28 PDPP Table 1 Allergy & Immunization Endocrinology Geriatrics Family Practice Infectious Diseases Internal Medicine Neurology Preventive Medicine Other Assignments Psychiatry Rheumatology General Practice-Dentistry Endodontics Periodontics Prosthodontics

29. 29 PDPP Table 2 Critical Care (Board Certified) Emergency Medicine Gynecology Hematology-Oncology Nephrology Obstetrics Occupational Medicine Pathology Physical Medicine & Rehabilitation/Physiatry/Spinal Cord Injury Pulmonary

30. 30 PDPP Table 3 Cardiology (Non-Invasive) Dermatology Gastroenterology Nuclear Medicine Ophthalmology Oral Surgery Otolaryngology

31. 31 PDPP Table 4 Anesthesiology Cardiology (Invasive) Colorectal Surgery General Surgery Plastic Surgery Radiation Oncology Radiology Refractive Surgery Therapeutic Radiology Trauma/Critical Care Surgery Urology Urologic Surgery Vascular Surgery

32. 32 PDPP Table 5 Cardio-Thoracic Surgery Neurosurgery Orthopedic Surgery Radiology (Interventionalist)

33. 33 Tier Definitions: Tier 1 Positions: Nonsupervisory direct patient care services. Scope: Clinic, dispensary, ambulatory care or ambulatory military treatment facility. Definition: Tier 1 physician and dentist positions involve the full range of cases, from those where the patients have common ailments to the very difficult, in a medical specialty. The most difficult and complex diagnostic cases may be referred to consultants at specialized facilities. Tier 1 positions may be responsible for medical students, interns, or residents assigned for training in their specialty. They may also engage in some research projects. This level is appropriate for most clinical and dispensary assignments.

34. 34 Tier Definitions: Tier 2 Positions: Direct patient care services and medical program managers. May involve program responsibility for Tier 1 facilities. All Tier 1 and Tier 2 supervisory positions are considered Tier 2 positions. Scope: Full patient care hospital Definition: Tier 2 physician and dentist positions involve the full range of cases, from those where the patients have common ailments to the very difficult, in a medical specialty and are located in full patient care hospitals. They serve as consultants on the most difficult cases and perform the most advanced diagnostic and treatment procedures at their facility. The most difficult and complex diagnostic cases may be referred to consultants at special facilities. Tier 2 positions may be responsible for medical students, interns, or residents assigned for training in their specialty. They may also engage in some research projects. This level is appropriate for most hospital assignments.

35. 35 Tier Definitions: Tier 3 Positions: Direct patient care services and medical program managers or researchers at medical centers and research facilities. Scope: Headquarters of major commands, medical centers, or medical research facilities. Definition: (A) Patient Care. Tier 3 physician and dentist patient care positions are typically located at specialized medical centers and are responsible for the most difficult cases where they routinely diagnose rare and difficult-to-identify symptoms and are responsible for developing a full-treatment regimen using emerging techniques and/or prolonged or complicated procedures. Cases are often critical and require immediate decisions because patients have failed to respond to previously-tried regimens. Within the Department of Defense, this level is typically found at medical research facilities and special DoD medical facilities (e.g., Walter Reed Army Medical Center for prosthesis, Brooke Army Medical Center for burn treatment, etc.). (B) Research and Administration. Tier 3 physician and dentist positions are typically located at headquarters of major medical commands with responsibility for medical program development and/or oversight of significant Command and/or Component or DoD level programs. Program development and/or oversight at this level do not require the physician and/or dentist to perform direct patient care functions. Tier 3 may also be appropriate for positions performing significant medical research.

36. 36 Tier Definitions: Tier 4 Positions: Component- or Department-wide specialty expert, specialty program manager, or nationally recognized researcher. Scope: Typically Command/Component headquarters or medical research facilities. Definition: Tier 4 physician and dentist positions are typically located at Command and/or Component headquarters and are Component- or Department-wide specialty experts, program managers of unique medical specialties, or nationally recognized researchers. Tier 4 positions do not require the physician and/or dentist to perform direct patient care functions.

37. 37 Tier and Table Assignment Examples Example 1: Physician A works as an Internist at an Army Medical Center. However, this physician is assigned to one of the branch clinics located within a troop command. As part of the training and rotational schedule, she is often asked to train a Family Practice resident during a two-month rotation. This position should be assigned to Tier 1. Example 2: Physician B works as an Internist at an Army Medical Center. This physician is assigned to internal medical clinic and sees many of the patients referred from the branch clinics along with a caseload of diabetes patients. As part of the training and rotational schedule, she is often asked to train Internal Medicine residents rotating through the clinic. Part of her patient load is inpatients with complications from diabetes. This position should be assigned to Tier 2.

38. 38 Tier and Table Assignment Examples (cont�d) Example 3: Dentist C is an endodontist practicing out of an Air Force Branch Dental Clinic. She sees a full load of endodontic cases and often receives referrals from the other local Branch Dental Clinics. This position should be assigned to Tier 2. Example 4: Dentist D is an oral surgeon assigned to the Dental Clinic within a Naval Medical Center. She is also an instructor and preceptor with the Navy Dental Residency Program in Oral Surgery. She is responsible for the training of oral surgeon residents during their rotation through the dental clinic. This position should be assigned to Tier 3. Example 5: Physician E is a radiologist who works primarily at a remote work site. The prime focus of her work is reading test results and images. Often she is consulted as an expert on complex oncology cases from facilities throughout the Navy. This position should be assigned to Tier 3. Without the national consultation the position would be a Tier 1.