Memorandum from C. Everett Koop to the Secretary (HHS) [on continued PHS participation at USUHS]
This memo shows Koop's early and abiding concern for maintaining the professional standards and quality of training for
the members of the Commissioned Corps of the Public Health Service, a mobile force of public health physicians, nurses, and
technicians formally under the command of the Surgeon General who can be deployed by the federal government in cases of epidemics
and natural disasters. The Commissioned Corps was suffering from uncertainty about its mission and a decline in morale after
reductions in personnel and the closure of Public Health Service Hospitals, the training ground for Corps members, in the
late 1970s and early 1980s. Koop considered his success in revitalizing the Commissioned Corps one of his most important
legacies as Surgeon General.
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4 (308,296 Bytes)
1981-12-11 (December 11, 1981)
Koop, C. Everett
United States Department of Health and Human Services. Office of the Secretary
This item is in the public domain. It may be used without permission.
Justification for Continuation of the Public Health Service Students and Faculty at the Uniformed Services University of the
-- USUHS is intended to represent all the uniformed services; without PHS the university would be a DoD university with emphasis
on training for combat readiness. PHS provides a focus on training in disease prevention; health promotion; and surveillance
techniques needed for such emergencies as Legionnaires Disease.
-- USUHS provides the only uniformed services training academy for future
development of an elite cadre of officers. There is no where else where such training can be obtained.
-- USUHS students are combat-ready for instant mobilization to meet military and national disasters. USUHS is the only place
where PHS students and military students train side by side. The closure of PHS hospitals removes the main source of supply
for commissioned officers who could serve immediately in national disasters.
-- USUHS faculty who are PHS officers are recognized by all services as the mainstream academic strength in the University
and provide an esprit de corps that is essential.
-- The required seven year pay back of students guarantees a cadre of PHS officers who would be available to meet the needs
of the PHS and must continue life time careers in the PHS.
The Uniformed Services University of the Health Sciences (USUHS) was established by PL 92-426 in 1972 with the signing of
the Uniformed Services
Health Professions Revitalization Act. This law requires that the University be located within a 25 mile radius of the District
of Columbia and that it be organized under the Department of Defense. USUHS is unique in that it is the only uniformed services
university of its kind specifically developed to prepare physicians. When resources become available other disciplines may
As the Surgeon General is a member of the University Board of Regents, the
PHS is a full partner in the development of the University policy. The School of Medicine is the primary functioning unit
of the University and its medical students are required to be commissioned in one of the four participating services (PHS,
Army, Air Force, or Navy). Participation in USUHS is designed to provide PHS with dedicated and career oriented medical officers
who have specialized training suitable for the varied missions of the Public Health Service.
Before USUHS accepted its first student class, the PHS and the University
began negotiations as to the level of support considered to be in the interest of the PHS. In an exchange of letters between
PHS and USUHS during 1974-1976, the PHS agreed to support approximately five percent of each entering class. Memoranda of
Agreements between PHS and USUHS concerning student and faculty support were signed in 1977.
PHS students who are accepted at USUHS must demonstrate a serious commitment to public service and have a high academic standing.
PHS students are given a comprehensive orientation by PHS staff in the history, traditions, organization, and broad mission
of the Public Health Service in a special pre-freshman orientation. These newly commissioned officers are also given training
in emergency medicine and search and rescue missions consistent with the PHS mandate to provide high quality medical care
to the U.S. Coast Guard and to assist the Federal Emergency Management Agency (FEMA).
Students are taught the necessary leadership and management skills to command medical units and organizations in the delivery
of health services in addition to the general medical curriculum. They are exposed to the problems of dealing with national
medical emergencies such as floods, earthquakes, and mass immigrations to this country. Over the years these experiences have
become commonplace for PHS officers. The traditional medical school does not prepare its students for involvement in these
types of activities. USUHS, however, does prepare medical officers for service in these activities.
Upon graduation, each officer is given a regular commission in PHS and has a seven (7) year active duty obligation to the
Service for the four years of supported medical education. Additional training such as in internship or residency is not credited
toward the seven year obligation. PHS officers graduating from USUHS are ready to function as medically trained personnel
in an emergency situation. For the PHS this would mean that there would be a cadre of individuals who could be assigned immediately
to cope with national emergencies.
Once students graduate from USUHS, the PHS is committed to support them for at least the internship year (GME-1 year) since
without an internship a graduate is not eligible for licensure. Students must apply for this first year of post graduate training
during their senior year. Approval of the request is made based on relevancy of the proposed training to PHS needs.
It was originally planned that these graduates would be assigned to PHS training programs for the GME-1 year and would be
supported by billets from these programs. With the closure of the PHS hospitals, all PHS internships have been eliminated.
Consequently, it is necessary that a number of billets be made available for this required year of training in non-PHS facilities.
PHS regulations require that in the absence of PHS training programs, USUHS graduates train in DoD facilities and if that
is not available, to obtain training outside-the-Service (TOS). We have established good working relationships with the offices
of the Surgeons General of the Army, Navy and Air Force and have been able to place our graduates in appropriate internship
and residency programs.
Over the last two years, PHS has filled its full complement of six faculty billets at USUHS. Faculty are selected from among
PHS officers who have been screened by both the USUHS and our PHS/USUHS Liaison Committee. Our faculty occupy high levels
of responsibility (Chairman, Department of Pathology; Associate Chairman, Department of Preventive Medicine and Biometrics;
Curriculum Director, Department of Pediatrics). They have direct student contact as well as conduct research in the various
departments. The PHS faculty participate in the full range of University activities and well represent the Service. They serve
as positive role models for our PHS students and students from the other military services as well.
In order that PHS continue to carry out its mission of improving the Nation's health, and to be responsive to national
emergencies, it is recommended that PHS continue its commitment for both students and faculty at USUHS at the present level
of six students per class and six faculty. This represents a reduction of student support from the originally agreed upon
five percent of each entering class to 3.5 percent of each entering class.