Title 38 Hybrid Physicians and Dentists Pay Plan (PDPP)

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Title 38 Hybrid Physicians and DentistsPay Plan
(PDPP)

• Steve Griffitts
• BUMED M1
• September 23, 2009

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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.

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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

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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

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GS Physicians Dentists Where They Are
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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

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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

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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

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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)

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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

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Conversion Process (contd)

• 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

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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.

Exceptions under prescribed conditions.
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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

See backup slides for complete table listing
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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

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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

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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

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Pay Administration

• Those under PDPP are ineligible for
• Physicians Comparability Allowance
• Premium pay ( except for compensatory time off
  for religious observances)
• Grade and pay retention

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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.

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Pay Setting New Hires (contd)

• 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.

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Pay Setting New Hires (contd)

• 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.

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Pay Setting New Hires (contd)

• 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.

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Pay Setting New Hires (contd)

• 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

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Pay Setting New Hires (contd)

• 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 activitys ability to
  recruit or retain well-qualified physicians or
  dentists.

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Pay Setting New Hires (contd)

• 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

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Pay Setting New Hires (contd)

• 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.

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Questions?
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BACKUP SLIDES
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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

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PDPP Table 2

• Critical Care (Board Certified)
• Emergency Medicine
• Gynecology
• Hematology-Oncology
• Nephrology Obstetrics

• Occupational Medicine
• Pathology
• Physical Medicine Rehabilitation/Physiatry/Spina
  l Cord Injury
• Pulmonary

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PDPP Table 3

• Cardiology (Non-Invasive)
• Dermatology
• Gastroenterology
• Nuclear Medicine

• Ophthalmology Oral Surgery
• Otolaryngology

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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

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PDPP Table 5

• Cardio-Thoracic Surgery
• Neurosurgery
• Orthopedic Surgery
• Radiology (Interventionalist)

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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.

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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.

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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.

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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.

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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.

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Tier and Table Assignment Examples (contd)

• 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.