By Col. James T. Currie, USA (Ret.), Ph.D.
There has been considerable discussion about the need to create a true reserve corps for the U.S. Public Health Service. The current PHS reserve does not provide the augmentation to active duty forces that are afforded to the federal military services by their reserve components. This paper represents an attempt by someone who is familiar with military reserve forces, especially those of the U.S. Army, to suggest a workable structure for a true PHS reserve corps.
I spent most of my thirty years of Army service as a member of the United States Army Reserve, including the Selected Reserve (troop program units and the Individual Mobilization Augmentee program) and the Individual Ready Reserve. I am also co-author of the official history of the U.S. Army Reserve: Twice the Citizen: A History of the United States Army Reserve, 1908-1995 (Washington, DC: Chief of the U.S. Army Reserve, 1997). Researching and writing this book afforded me a unique perspective from which to understand the rationale behind the creation of the Medical Reserve Corps (MRC), which was the first federal military reserve organization. (The National Guard traces its lineage to a Massachusetts unit that was organized in the early seventeenth century, but these are state forces, and in 1908 there was some question about whether they could be accessed by national authorities). It also gives historical lessons as to how a reserve component for the USPHS might be structured.
The U.S. Army Medical Reserve Corps, predecessor to today’s Army Reserve, was created in 1908 as a result of lessons learned from the Spanish-American War. In 1898 the Army had a complement of physicians that was sufficient in number to take care of its needs in peacetime. When war with Spain occurred in, however, the Army grew in size, injuries from combat and disease suddenly became an issue, and the Army recognized that it did not have enough physicians on its rolls. “Contract surgeons” augmented those in the Army ranks, just as they had during the Civil War (1861-1865), but these civilian doctors were not as flexible in their assignments as were those in uniform. They could not necessarily be sent where they were most needed, as could doctors in uniform.
The Army leadership of the time decided that the answer to a wartime physician shortage was to reach into the civilian community and offer Reserve commissions to physicians who would agree to come onto active duty in time of war. To attract civilian doctors, the Army contacted the most prominent among them: the Mayo brothers, offering them commissions as lieutenant colonels (O-5s) in the Medical Reserve Corps. Recruitment into the Medical Reserve Corps went so well that it was soon expanded to include nurses and ambulance drivers. The ranks of the MRC had reached 160,000 by the time the United States entered World War I in 1917. From this modest beginning has come today’s U.S. Army Reserve, a force of about 450,000, including 4,000 Individual Mobilization Augmentees.
It is this last category of reservists—IMAs—which I believe offers the best model for a USPHS reserve. IMA soldiers are assigned to a particular Army unit or organization and perform 12 days of active duty a year. If they fall into the category of “Drilling IMA,” they also perform two days of duty a month at their assigned station. There are both commissioned officer and enlisted soldier IMAs in the Army, but for now, I will focus only on the officer side. Many of these IMAs previously served on active duty and then embarked on civilian careers that develop skills needed by the Army but for which enough active duty positions have not been provided. The author, for example, was for five years a drilling IMA with the Army’s Office of Legislative Liaison in the Pentagon. This is the office that represents the Army to Capitol Hill, and as a former Hill staffer, I was a logical fit to augment the active duty soldiers and civilians who worked there. As a Reserve colonel, I performed active duty each year when an active duty colonel in the office wanted to take a vacation. I was as knowledgeable about the Congress as were the officers who served regularly in OCLL, thus the office did not lose capacity because a Reserve officer had taken a position there.
This could be the model for the Commissioned Corps of the USPHS. The idea would be to contact civilians who have the skills required to be an officer in the Commissioned Corps of the USPHS and offer them Reserve commissions, the rank to be determined in the same manner as active duty PHS accessions. These officers would go through the Officer Basic Course with active duty PHS officers and would be assigned to fill a billet that would correspond with one held by an active duty PHS officer.
The benefits would be immediate. Using the Indian Health Service as an example, a Reserve physician or dentist or nurse or pharmacist would be called to active duty whenever one of the clinicians at a particular IHS facility wanted to take two weeks of vacation time or depart their job at the IHS to go on a deployment. As the system works now, officers assigned to the IHS are frequently denied the opportunity to deploy because the leadership of the IHS feels that they cannot endure the shortage of that particular officer’s skills. Having a Reserve physician or dentist or nurse or pharmacist available to fill the billet occupied by the active duty PHS officer would allow the active duty officer to deploy or take vacation without degrading the quality of care provided at the IHS facility to which they are assigned. This would be particularly effective if the PHS Reserve IMA regularly completed 12-day tours at the facility to which they were assigned.
Exact costs of implementing a PHS Reserve IMA program are hard to estimate, as there are many variables. It is anticipated that the cost of the program would largely fall onto the agency or department to which the Reserve PHS augmentee was assigned, as that is where most of the benefits would accrue. Even if Reserve PHS officers were afforded the same benefits as federal military IMA officers, the costs would not be great.
The benefit to the employing agency is that they would have the services of a qualified clinician who could augment the full-time staff, filling in when an active duty PHS officer was absent. The benefit for the Commissioned Corps officers would be palpable. Agencies would not be reluctant to release an officer for deployment if they knew that a qualified replacement would be immediately available. The benefit to the augmentee would be the privilege of serving in uniform, qualifying for some no-cost benefits like exchange and commissary, and perhaps ultimately qualifying for a modest retirement. The benefit for the Public Health Service itself would be enormous. It would instantly create a corps of prominent civilian supporters in every state, thus increasing understanding of the Commissioned Corps and its mission at the local level and greatly increasing the corps’ recognition and acceptance in the Congress.
We know that there has been some discussion of using the Coast Guard Reserve as a model for the USPHS. We think that the Army IMA model might be a better fit for the Commissioned Corps, and we urge the Office of the Surgeon General to explore such as an alternative to a Coast Guard model.