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October 8, 2010

Dr. Red, White and Blue: Practicing medicine with the federal government

Serving as a physician with the U.S. governmentThe United States government hires a whole lot of people. According to the Bureau of Labor Statistics, there are about 2 million civilian employees, excluding the U.S. Postal Service, and about 85 percent work outside the Washington, D.C.  metropolitan area. Generally, the pay is competitive and the benefits - especially healthcare and retirement - typically exceed those in the private sector.

The federal government is flush with jobs for physicians. Some of those jobs are fairly obvious, such as with the Veterans Affairs (VA) and the Department of Health and Human Services (HHS), which oversees divisions such as the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). Others, such as the State Department and the Federal Bureau of Prisons, might not be quite as obvious. Here are six federal agencies with opportunities for physicians seeking employment.

Department of Veterans Affairs

Not surprisingly, the VA is a major employer of physicians, with approximately 18,500 doctors on its payroll. The agency operates 153 hospitals, but it has more than 1,000 points of care, such as community-based clinics, throughout the country. In addition, the VA is one of the largest trainers of physicians in the country. Joleen Clark, MBA, chief officer of workforce management and consulting for the VA says, "We have about 35,000 residents that rotate through annually and about 18,000 medical students."

Clark says that they encourage those trainees to stay with the VA after residency, "but like any organization, you can only have so many new people. You want new people with your experienced people. It’s a mix. We look for all levels of experience within that scope," she says.

"We have about 35,000 residents that rotate through annually and about 18,000 medical students," says Joleen Clark, MBA, chief officer of workforce management and consulting for the VA.

Because of the numerous facility types, the VA has a need for all specialties, although the needs will vary from institution to institution. Clark says, "If it’s a large tertiary care facility, they’re going to have all the subspecialties there, so the complement of physicians and specialties is going to be very broad compared to one of our rural facilities."

The size of the organization also benefits physicians’ career trajectory. "Because we are such a large organization there is plenty of room for advancement," Clark says.

The pay for VA physicians is not as high as most physicians would get in private practice, but they fall under Title 38, which outlines veterans’ benefits. It’s market-based, competitive, and no malpractice insurance is required because of the VA tort claims system. Clark says, "We have a good benefit package and really regular hours. Even though they’re on call 24/7, it’s really an 8 to 4:30 shift."

The VA currently hires about 3,000 physicians annually. Clark says, "Licenses are transferable; you just need to have a license in any state to practice anywhere in the country."

Physicians interested in jobs with the VA should visit the official website.

The Federal Bureau of Prisons

There are 115 federal prisons in the United States, staffed by approximately 36,000 federal employees. Although the prison system currently has 222 physicians, doctors remain one of the agency’s greatest needs, especially family practitioners, general practitioners and internal medicine specialists. Institutions housing female inmates also need OB/GYNs.

Cathi Litcher, activation coordinator with the Federal Bureau of Prisons (FBOP), says, "We are a federal law enforcement agency, but doctors do not need to meet that minimum age limit because they are mission critical. Congress has made an exemption for doctors and psychiatrists."

John King, the FBOP’s medical recruiter, says, "As long as you’re a licensed physician, completed your residency and your training [regardless of board certification] and have no restrictions, and a U.S. citizen, you’re qualified to work for us."

Like many federal government jobs, federal prison jobs can be found at usajobs.com. King points out that unlike the VA’s Title 38 pay grades, the FBOP pays physicians on the Title 5 federal government pay scale (civil service). Physician salaries range from $120,550 to $155,500. "Most of the time, a doctor with two to three years’ experience, we’re going to bring them in at GS-15, step 10, which is $155,500 each year - provided the applicant’s current salary meets or exceeds that level," King says. In addition, the bureau of prisons has a Physicians Comparability Allowance (PCA). According to King, the allowance means board-eligible physicians earn an additional $12,000 each year; board-certified doctors pocket an additional $14,000. After two years of service, the PCA is automatically increased to $18,000 and $23,000, respectively.

To entice physicians further, the bureau of prisons can throw in an additional 25 percent on top of the base pay at the discretion of the CEO of the individual institution. Lastly, most FBOP sites are approved to participate in the National Health Service Corps loan repayment plan.

Prison physicians work a 40-hour week, Monday through Friday, with an on-call rotation to cover weekends. The benefits package typically available to federal employees applies to doctors employed by the prison bureau.

The most typical question a physician considering the federal prison system asks is, "Is it safe?" Litcher says doctors in a local hospital have to depend on hospital security if there is a problem with a patient or family member. In the federal prison, trained correctional officers respond immediately to keep physicians safe. "You’d feel a lot safer because you have more control mechanisms."

For more information, visit the Federal Bureau of Prisons website, bop.gov, or contact John King at [email protected]

Indian Health Service

The Indian Health Service (IHS) is a division within the Department of Health and Human Services. Its primary function is to provide health care to Native Americans and Alaskan natives. It currently serves about 1.9 million people or about half of the Native American and Native Alaskan population. Through its 48 hospitals and 230 small clinics in 35 states - mostly in the western and northwestern part of the country - its predominant service is primary care, though some tertiary and specialty care is available.

Susannah Olnes, MD, is a pediatrician and the lead physician recruiter for IHS. She

Susannah Olnes, MD, pediatrician and lead physician recruiter for the Indian Health Services (IHS), spent part of her career practicing in rural Oklahoma and Alaska. She says the biggest challenge for most physicians looking to practice within the division is the remoteness of the sites.

Susannah Olnes, MD, pediatrician and lead physician recruiter for the Indian Health Services (IHS), spent part of her career practicing in rural Oklahoma and Alaska. She says the biggest challenge for most physicians looking to practice within the division is the remoteness of the sites.

says, "Clinics are typically on or near reservations. They’re very rural, so that means they’re located in very small, isolated sites." There are also some critical care hospitals and larger facilities in Anchorage, Ala.; Gallup and Shiprock, N.M., and in Oklahoma.

Capt. Carmen Clelland with the IHS recruitment branch, says, "Some of the things we are looking for are physicians interested in rural practice. We also want them to participate in the community. Many times the physicians will be leaders," he says. "Physicians have quite a bit of experience and knowledge - not only in the health center - but to the community, whether it’s through presentations, their practice, or through the clientele they serve."

Technical qualifications are fairly standard - board eligible or board certified, and licensed. Olnes says, "We’re looking for physicians like everyone else, but we do have a special population. We’re in special areas, rural areas, where there’s not much specialty care immediately available. It takes a special physician to work in many of our sites, [someone] who’s comfortable with not having those specialists right at hand," she says.

Salaries are market-based and fall under the civil servant pay system. Tribal leadership also has leeway to increase pay, so salary is often at market rates or higher. Though
the tribe determines pay, physicians report to their medical departments’ chiefs of staff or clinical directors, according to Clelland.

Olnes, who spent part of her career practicing in rural Oklahoma and Alaska, says the biggest challenge for most physicians is the remoteness of the sites. "Most young doctors, residents, and even older physicians are practicing in urban settings, so they are used to living in urban areas. I grew up in New York City, but there’s a whole other world that is a wonderful place to live and we try to share that with our doctors - once you’re integrated into these communities there are just wonderful community experiences they can have," Olnes says.

There are several tracks that a physician can use to apply. One is usajobs.gov. The IHS website, ihs.gov, also has job links. Tribal websites also often have job postings for physicians.

Department of State Office of Medical Services

The State Department operates embassies and consulates all over the world. The State Department’s Office of Medical Services provides health care in many of those embassies or consulates, primarily in countries where local care is inadequate.

Looking for an adventurous job outside the typical 9-to-5, Monday-through-Friday gig? Kathleen Glaser, deputy director of the Foreign Service health practitioner program, says that State Department physician positions fit the bill.

Looking for an adventurous job outside the typical 9-to-5, Monday-through-Friday gig? Kathleen Glaser, deputy director of the Foreign Service health practitioner program, says that State Department physician positions fit the bill.

Kathleen Glaser, the deputy director of the Foreign Service Health Practitioner program, says, "The medical office is inside the embassy and we take care of American diplomats. The providers are employed by the State Department or hired locally by the Embassy." According to Glaser, in addition to diplomats, people working within an embassy could include staff from the Department of Agriculture and Homeland Security. "Any official federal employees assigned to the embassy would fall under our umbrella," Glaser says.

Typically, embassies need family practice doctors, but the department also hires nurse practitioners and physician assistants. Glaser says, "The physicians are regional and usually cover multiple locations, while the other practitioners are usually at one specific location and are supervised by the physicians in that region."

Embassy populations range in age from 6 weeks to 60 years. Glaser says, "We have kids, spouses, employees. Children up to the age of 21 can usually be with their families." The healthcare - as well as the housing - provided is part of the embassy employees’ benefits. State Department housing is usually furnished and transportation is provided from the United States to the country of service.

Embassies vary greatly in terms of number of employees, some with as few as 30 people and some as many as 1,000.

Glaser says that State Department physician positions are for adventurous people who want to do something outside the normal 8 to 5, Monday through Friday job. "A lot of our people are former military, were born overseas, or lived overseas at some point in their lives and like that environment. They like to travel and they like different cultures," she says.

State Department medical assignments last two to three years. The physicians then rotate either to another country or often back to Washington, D.C. Glaser worked  overseas for 15 years before rotating back home. In her years with the State Department, she worked in Chad, Israel, Ukraine, Cuba and China.

Physicians interested can find postings at the State Department’s website.

Centers for Disease Control and Prevention (CDC) and the Epidemic Intelligence Service

Physicians for the CDC fall under a fairly complicated and confusing area of federal medical jobs known as the U.S. Public Health Service (USPHS), which falls under the purview of the Surgeon General, who reports to the Secretary of the U.S. Department of Health and Human Services (HHS). The Public Health Service is a uniformed service and uses a rank structure similar to the Navy. However, it is non-military and has an all-officer corps.

The CDC employs approximately 15,000 people, 10 percent of whom have medical degrees of some type.

Capt. Douglas H. Hamilton, MD, Ph.D., is the director of the Epidemic Intelligence Service (EIS). Hamilton says of the epidemiology fellowship, "This job is fun. You’re on the leading edge of a lot of major public health issues, dealing with unique problems - some scary, usually interesting - and it really is an opportunity most people don’t have."

Capt. Douglas H. Hamilton, MD, Ph.D., is the director of the Epidemic Intelligence Service (EIS). Hamilton says of the epidemiology fellowship, "This job is fun. You’re on the leading edge of a lot of major public health issues, dealing with unique problems - some scary, usually interesting - and it really is an opportunity most people don’t have."

Capt. Douglas H. Hamilton, MD, Ph.D., is the director of the Epidemic Intelligence Service (EIS), a department within the CDC. According to Hamilton, the program is one of the main entry points for medical doctors at the CDC. A two-year postdoctoral fellowship program started in 1951 with the goal of training epidemiologists, the program is analogous to a medical residency or fellowship.

The program begins with a month of didactic training. Officers are then assigned to different branches across the agency. About two-thirds are based at the agency’s headquarters in Atlanta; the remaining participants are placed into state and local health departments.

The EIS takes an average of 80 people each year. Approximately 60 to 65 percent are medical doctors; 20 percent are Ph.D.-level scientists; 5 to 10 percent are veterinarians; the rest are nurses, dentists, and physician assistants with MPH degrees.

Hamilton says, "The focus of the training is what we call applied epidemiology. It’s learning to do field investigations, but it’s also learning to deal with large studies or datasets when you’re not necessarily in the field." According to Hamilton, there isn’t a typical epidemiological experience, because at any given time, there are 160 scientists in the program. "It’s different for each position. There are 160 different experiences that are based primarily on where you’re assigned," he says.

Most EIS participants have completed a residency, although some come right out of internship. According to Hamilton, "The minimum requirement is you have a medical license, but most of them are further along in their careers. We do get a fair number of people who have done fellowships and about 60 percent of our physicians have some sort of advanced degree, typically an MPH."

The assignments are throughout the country, including Hawaii, Alaska and Puerto Rico. Hamilton says that the pay isn’t quite up to the average for a permanent physician job, but it’s better than most residency positions. Typical pay for the fellowship is a straight salary of about $68,000 for the first year and $70,000 to $72,000 for the second year. According to Hamilton, pay for physicians who enter the corps system is based on rank, the same pay military doctors receive. The advantage for commissioned officers is that some of the pay is actually tax-exempt," Hamilton says.

Physician salaries in other CDC departments fall under civil service or Title 38 pay scales.

Hamilton says of the epidemiology fellowship, "This job is fun. You’re on the leading edge of a lot of major public health issues, dealing with unique problems - some scary, usually interesting - and it really is an opportunity most people don’t have," he says. "For most people, it’s probably the last time in their careers that they can focus on learning and doing and not have to deal with all the administrative crud physicians deal with these days. You’re not managing an office, you’re not hiring staff, you’re not doing billables. You’re focused on learning epidemiology and public health."

An online application is available on the CDC website.

National Institutes of Health

The National Institutes of Health (NIH) is primarily concerned with conducting and supporting medical research. For physicians, the focus is on turning scientific discoveries into practical medical applications. Frederick Ognibene, MD, the clinical center deputy director and the director of the office of clinical research training and medical education, says, "My office handles programs and courses that are directed toward clinical and translational research, so it involves some undergrads, and medical and dental students. We also have a variety of positions for physicians who are still junior, but further along in their training that are doing either primary residencies or fellowships."

Young physicians in internal medicine, pediatrics or surgery, have an opportunity to come to NIH to receive additional training in a subspecialty. That fellowship usually involves direct patient contact and research in a clinical environment.

Ognibene says the NIH also has positions called staff clinician physicians, "which are more clinical in nature, but they work collaboratively with their colleagues who are doing more basic or bench research as part of the research time, and they help facilitate some of the clinical trials and protocols that are being done here," he says. "It’s research in a sense of being part of a research team, not the classic concept of someone hunched over a bench in a lab."

The NIH, which manages millions of dollars in research grants, also offers physician positions involved in the administration or management aspects of the organization. Ognibene says, "That is primarily in the realm of grants, because of the physical NIH campus in Bethesda, Md., where we have our hospital and research labs, is only a small component of what the NIH is. The bulk of the NIH is the wide-reaching academic research community around the country."

Ognibene started with the NIH as a clinical fellow and later became a senior investigator in the center’s critical care medicine department. "There are certainly many positives. It’s an environment where you can work with different disease entities and areas of interest. The overarching mission is to do research here to improve the health and well being of the nation and the world. I know that sounds grandiose, but it’s what we do well." Ognibene says that working for the NIH allows scientists the opportunity to work on translational research without having to compete with peers for grants to sustain research.

Compensation is probably slightly lower than would be found in similar academic situations and certainly less than in pharma, but it’s a financially secure employment with the usual federal benefits boosted further by academic stimulation.

Ognibene says, "It’s a place to do things that are cutting edge, exciting and linked to the mission and goal of the NIH. It’s a great collegial, collaborative, academically rich and intellectually stimulating environment."

Physicians interested in the NIH can work through the agency’s personnel program, although Ognibene admits that due to NIH’s size and structure, navigating the system can be a little tricky. He says, "That’s an overarching, administrative way to deal with personnel, but when it comes down to practicality, look at the various institutes and programs’ jobs availability." The website is jobs.nih.gov

Mark Terry is writer, editor and novelist specializing in health care, practice management and clinical diagnostics. He lives in Michigan with his wife and two sons. For more, visit markterrybooks.com.



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