Origins of the US Public Health Service
The Commissioned Corps of the US Public Health Service (PHS) is one of seven uniformed services along with the Army, Navy, Marine Corps, Air Force, Coast Guard, and Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA). The Army, Navy, Marine Corps, and Air Force are within the Department of Defense (DoD), and the Coast Guard, within the Department of Homeland Security. These five services compose the armed services of the military. The remaining two services also are uniformed, but not armed services, and are located in other federal departments. NOAA is within the Department of Commerce, and the PHS within the Department of Health and Human Services.
Although the US Public Health Service may be less familiar than our sister armed services, it can trace its origins back to 1798. It was in this year that Congress passed an act for the relief of sick and disabled seamen that formed the basis of the Marine Hospital Service. In 1889, the Commissioned Corps was formally established within the Marine Hospital Service. By 1912 this service became formally known as the U.S. Public Health Service when its mission expanded to include investigation and surveillance of disease. This important work in public health sustained the service when its original mission ended with the closing of the Marine Hospitals and Clinics in 1981.1 The current mission of the Public Health Service is protecting, promoting and advancing the health and safety of the nation.
Originally an all physician corps, the PHS Act of 1944 added several disciplines including nurses and physical therapists to the corps.1 Currently there are approximately 6,000 Commissioned Corps officers on active duty organized into 11 professional categories of health and public health-related disciplines2. The Therapist Category is composed of 96 physical therapists and 43 others including occupational therapy, audiology, speech language pathology, and soon respiratory therapy.3 As one of the seven uniformed services, PHS physical therapists’ pay and benefits are similar to those provided by the DoD services.
Opportunities in the Public Health Service
Commissioned officers of the PHS can be assigned to any of 12 Â operating divisions within the Department of Health and Human Services and elsewhere in the federal government (see box). Nearly all the uniformed health care providers serving in the U.S. Coast Guard are PHS commissioned officers. The relationship between the two services dates back to the 1798 Act that created the Marine Hospital Service.1
Indian Health Service. Nearly 60 percent of the physical therapists within the PHS serve in positions within the Indian Health Service (IHS).3 In the treaties of 1784, the Federal Government acknowledged certain responsibilities toward indigenous people, which included health care.4 In 1955, this responsibility for providing health care to American Indians and Alaska Natives was transferred from other programs to the newly created Indian Health Service within the PHS.1 Today, the IHS provides health services to approximately 1.9 million Native Americans who belong to more than 562 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units with a $3.35 billion budget. The IHS also annually generates approximately $780 million in additional revenue from third party collections for the health care they deliver.5 Most physical therapists assigned to the IHS serve on the Navajo
Reservation, and in the Alaska, Oklahoma, and Phoenix areas. They are vital members of multi-disciplinary healthcare teams providing comprehensive care in both ambulatory and in-patient settings.
Physical therapy services include specialty care in diabetes, geriatrics, wound care, pediatrics, hand and foot care, health promotion and wellness programs, NCV/EMG electrophysiological examination, orthopedic, neurological, cardiopulmonary, and amputation rehabilitation, pain clinics, and clinical education. New programs have been established in women’s health and phase two cardiac rehabilitation. Rehabilitation departments in Indian Health also provide facility employees with wellness and fitness programs, back care education and ergonomic evaluations. Due to the unique settings in the IHS, practice opportunities also include non-traditional community outreach, preventative education and cultural appreciation.6 In addition to the pay and benefits available to all PHS officers, some additional programs may be available for officers serving in the IHS. Participation in the IHS Student Loan Repayment Program may be possible depending on eligibility and funding availability. Officers serving in more rural locations also receive special recognition for their service.
Bureau of Prisons. The next most common area in which PHS PTs practice (25 percent) is the Federal Bureau of Prisons (BOP).3 Located within the Department of Justice, the BOP was created by law in 1930, and it included a provision to assign PHS officers to the Bureau to provide medical care to inmates.1 Inmates assigned to the BOP must be convicted of violating federal, not state or local laws. About half the offenses are drug violations, followed by a variety of other convictions. The total population in the BOP is just over 200,000. The typical inmate is male with an average age of 38 serving a sentence of 5-10 years.7 While serving their sentences, the BOP provides to inmates “essential medical, dental, and mental health services by professional staff in a manner consistent with acceptable community standards for a correctional environment”.7 Annual health care costs in the BOP in 2004 were approximately $624 million.
When inmates have health conditions that are expected to require substantial or ongoing care, they may be transferred to one of six specially designated medical centers within the BOP. These medical centers include the resources typical of many community hospitals including inpatient services which are adapted to the correctional environment, and all include physical therapists on their staff. The BOP also has physical therapists working at facilities one care level below the medical center. The inmates at these facilities often require physical therapy for chronic medical needs. BOP therapists evaluate and treat either male or female inmates with a wide range of musculoskeletal, neuromuscular, integumentary, and cardiopulmonary diseases and conditions. Physical therapy services include specialty programs such as NCV/EMG electrophysiologic evaluation, Back School, and clinics with focus on the shoulder, pain, orthopedics, or orthotics and prosthetics. PTs provide wound care, evaluation and management of insensate limbs, functionalassessments, and cardiac rehabilitation. BOP therapists also host students through clinical education programs.
To support recruitment efforts, the BOP sponsors students through the Senior COSTEP scholarship program8 and has supported PHS students who completed their physical therapy degrees in the Army- Baylor education program. The therapists in the BOP receive special recognition for their service in a correctional environment. Clinical Research. Another operating division to which a few PTs are assigned is the Clinical Center of the National Institutes of Health, the nation’s premier research hospital for conducting clinical research to improve health. Physical therapists have contributed to clinical research in many specialty areas, including oncology, arthritis, cardiopulmonary, and movement disorders. In the past, physical therapists have supported clinical research efforts at the National Hansen’s Disease Program in Louisiana. Discoveries made there not only have minimized the disability associated with leprosy, but electromyographic evaluation methods have expanded to many diagnoses, and practice models have been translated to the care of the insensitive diabetic foot well beyond the Program. Physical therapists also have served at the National Institute of Occupational Safety and Health, a part of the Centers for Disease Control and Prevention, contributing expertise in the assessment of musculoskeletal injuries and ergonomics to improve the health of workers at their job sites.
Applied Public Health. Throughout the PHS, physical therapists support or have performed clinical, research, regulatory, and administrative functions at various operating divisions to protect, promote, and advance the health and safety of the nation.
These included assignment locations such as the Office of Disease Prevention and Health Promotion, the Centers for Medicare and Medicaid, the Agency for Healthcare Research and Quality, the Food and Drug Administration, other offices under the Secretary of the Department, and even sites you may not expect such as the US Department of Agriculture and the Environmental Protection Agency.
Other opportunities. During times of war, the Commissioned Corps has been militarized by the U.S. President. The first time was during World War I in 1917. PHS Officers were detailed to the Army and Navy primarily to help control the spread of disease during large troop movements, because disease had caused more war fatalities than wounds up through World War I.1 Even though the PHS has not been militarized since the Korean War, PHS officers have continued to provide support for DoD health related activities, primarily in the States, so DoD officers can deploy overseas. Recently the PHS has participated in DoD humanitarian training missions in Latin America and the Pacific. In addition to supporting DoD missions, the PHS offers short term deployment opportunities of several weeks to a month for its own public health related missions. Physical Therapist Officers were honored to deploy with their PHS colleagues to missions such as Fort Dix, NJ to assist Kosovo refugees, the World Trade Center site, and many southeast hurricanes, including Katrina in 2005.3
As a Commissioned Corps, there are many opportunities for PHS physical therapists to serve our patients and our nation. Over the course of a 20 to 30 year career, a physical therapist’s first assignment will typically be in an IHS or BOP clinic. Subsequent assignments may include increasing responsibilities in the clinic or take other directions into applied public health and program management. In a uniformed service, each assignment offers new challenges and opportunities while building seniority within a single personnel system that invests credit toward retirement. Short tours in the inactive reserve corps also may be available for physical
therapists interested in making a smaller commitment to serve.