A Career Plan for Medical Officers

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-06180A000200070002-7
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 10
• Document Creation Date: November 11, 2016
• Document Release Date: July 31, 1998
• Sequence Number: 2
• Publication Date: September 18, 1962
• Content Type: MF

Approved For Release 1999/09/20 :DP78-06180A000200070002-7
NEMDRANDUM FOR: Chief, Medical Staff
SUBJECT : A Career Plan for Medical Officers
REFERENCE : Medical Staff Career Service Meeting -
C/MSS Appointed Committee of 8 May 1962
1. The Committee members are in agreement. It is possible for
the Agency to have a medical officer career program. However, such a
program could embrace only a limited number of doctors of a particular
type. An Agency medical officer career program could not in any way be
compared with those of other United States Government agencies or
departments. The total number of doctors which can be accommodated in
other than nonclinical operational capacities is exceedingly small.
Realistically, the Agency's clinical needs for a specialty one-time
specific assignment and those of an unpredictable nature can best be
satisfied by contract employees.
2. An examination of the major factors fundamental to a possible
career program is also pertinent to the employment of all physicians by
the Medical Staff for the Agency, particularly those physicians at
Headquarters. This report is subdivided into the following parts:
a. A Medical Officer Career Program
b. Interpersonal Relationships and Staff Working Environment
c. Training
d. Salary and Promotion
e. Administration
f. Summary
g. Recommendations
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SUBJECT: A Career Plan for Medical Officers
3. A Medical Officer Career Program.
a. To make a medical career with the Agency appealing to a
physician, there must be a detectable plan for a career. A possible
program, covering the first eighteen years of employment for each
general medical officer, is outlined here. This program calls for
two overseas stations, each with a senior and a junior medical officer;
and four additional one-medical-officer stations, either overseas or
at Headquarters, medical or nonmedical, or with domestic components.
The principles of this plan are:
(1) Two years of Headquarters Medical Staff professional
briefing, training, and duty to determine the advisability of
assignment overseas and future career planning,
(2) An initial year of Agency training and language studies,
(3) A system of three-year tours in either Headquarters,
domestic, or overseas assignments,
(4) Three years for specialty training,
(5) Experience for each medical officer in at least two
major geographical areas,
(6) Six phases of career development, during which
suitability for additional responsibility and authority may be
determined,
(7) Ultimate duty at Headquarters as chief of division,
deputy chief of the Medical Staff, or chief of the Medical Staff
prior to retirement, and
(8) All positions not occupied by career personnel should be
filled by contract physicians.
b. A physician employed with a view to being a member of the
career program should: be under forty years of age; have completed
his internship; be licensed in at least one state; and have his military
obligation completed.
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c. During his first and second years, he should be given an
opportunity to serve three months in each of the four divisions of
the Medical Staff, covering clinical, psychiatric, operations, and
support matters, and to have one full year thereafter in the division
of his choice. This will indicate his apparent major medical interests
and give time to prepare for an official cover position overseas. The
Medical Staff can, during the period., decide whether or not the physician
should be assigned overseas and he can, likewise, make up his mind*
d. In the third year of duty, the newly acquired physician would
be required to complete, successfully, Agency training in the Operations
Course and the Basic Paramilitary Course and attain language proficiency
in at least one language. This period will give an additional indication
of whether or not he is going to identify with, have empathy for, and
become reasonably proficient in rendering support to one or more aspects
of the Agencyts business. It will also give an indication of whether
or not he is a well-integrated person. If he does not do well in his
train, the Medical Staff should not consider him favorably as a
long-term investment and he should make plans to go elsewhere.
e. The dependents of the physicians should also be evaluated
during the same initial three-year period to determine their suitability
and adaptability for overseas assignments and to accompany the doctor
through a career with the Agency*
f. The fourth through sixth years of service should be spent as
the junior medical officer at one of the stations having two Agency
physicians. The senior physician for this period would be able to
submit his evaluation of the newcomer relative to performance and
suitability in an overseas situation.
g. The seventh through ninth years would be his first tour at
a single physician station,
h. The tenth through twelfth years would be an assignment to
Headquarters. If considered appropriate, specialty training or other
useful Agency postgraduate study could then be provided.
L, The thirteenth through fifteenth years would permit the second
single-physician station assignmente
j. The sixteenth through eighteenth years would permit the medical
officer a tour as the senior medical officer at a two-man station.
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k. The subsequent years prior to retirement would be in
Headquarters medical positions, including those of the deputy
chief of the Medical Staff and the chief of the Medical Staff.
I+. Interpersonal Relationships and Staff Working Environment,
a. The nature of interpersonal and staff relationships between
Medical Staff lay and professional personnel has a significant
effect upon the career of a medical officer. Men and women prepare
themselves for a career in medicine for many personal reasons,
including status and prestige, idealism, social position, power,
pride, and pay. Most physicians are individualists and many can be
leaders, but few survive for long as subordinates. Seldom does a
physician remain where his needs are not satisfied. To consistently
attract and retain the services of well-trained, experienced, and
capable physicians, the Agency must provide a challenging position.
It is also essential that every effort be exerted toward developing
and maintaining an appropriate professional climate.
(1) There must be evident recognition of the fact that any
group and particularly a group of physicians prospers when there
is a stimulation of incentive, a sharing of responsibility, and
a delegation of authority from higher to lower echelons in an
organization. When there are no rewards for extra effort and when
decisions within the realm of ability, authority, and responsibility
of physicians are dictated by supervisors, any person, even a
physician, withers.
(2) Great care must be taken to avoid a professional climate
of servitude, which invariably vitiates a physician's interest and
prompts an irreversable process of disengagement, seeking other
fields. The optimal environment can be established by giving
responsibility and authority for money, materiel, duty hours, and
production criteria to each physician-supervisor without intervention
unless mistakes are made.
be Sincere effort must be exerted to maintain dignity among
professional personnel and to eliminate circumstances which tend to
disparage or derogate them. Any act should be avoided which appears
to the professional staff as unwarranted favoritism, intimidation, or
allurement. A firm understanding must be evident that physicians are in
charge of and have authority over all Medical Staff functions and that
the other personnel are required to assist them in the accomplishment of
these responsibilities.
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SUBJECT: A Career Plan for Medical Officers
(1) Medical administrative-type personnel must not direct,
assume a role or posture which is not in proportion to their
value or training or which would be inappropriate to a good
medical professional activity.
(2) Medical administrative-type personnel must not be
permitted to be competitive with professional personnel, rather
they must play a minor role in policy-guidance and policy-making.
(3) The reservations regarding the feasibility of an action
should not need to be a primary concern of medical administrative-
type personnel, but an attempt should be made to determine how
they can assist physicians to meet their responsibilities.
(4) Medical administrative-type personnel must recognize
that they are in subordinate employment positions and have
comparatively inadequate educations. Physicians will not
normally accept any assumption and exhibition of power, control,
direction, and obstruction from laymen.
(5) Medical administrative-type personnel must know that
doctors will not favorably evaluate an employment climate where
control is centered in an administrative-support facility.
(6) Medical administrative-type personnel must be guided
primarily by clinical and operational necessity as determined
by a physiciants responsibilities and authority.
(7) Physicians in a career service would feel more secure
in their positions with the knowledge that their division chief
controls the filling of slot vacancies for all division personnel.
Medical administrative-type personnel must include their own
personnel in filling vacancies rather than demand personnel
already engaged in clinical and operational activities*
co The stature of physicians in the professional climate of the
Medical Staff must be on an earned basis (including years and nature
of experience). Changes reflecting increases in responsibility and
authority must be made with the full knowledge of professional
contemporaries and superiors, thereby, eliminating any question of
favoritism, which naturally carries with it many unpleasant implications
and results logically in an erosion of physician interest and respect
for a professional career in the Agency.
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SUBJECT: A Career Plan for Medical Officers
d. The Medical Staff should assure an atmosphere wherein
the normal aspirations of physicians can be fostered. Young
physicians seek assurance that their prolonged associations will
be with seniors who are more competent, have higher professional
stature and social position. Without this, they soon become
disillusioned and realize they must go elsewhere to re-enter a
true clinical community and re-establish themselves in their
profession. Any physician who remains where less than optimal
conditions prevail is either not ambitious, highly idealistic
regarding the goals of the organization, absorbed in a particular
professional matter which intrigues him, or has a desire to reform
and improve on the current administration*
e. The Medical Staff must follow carefully a planned program
which is obvious to all medical personnel and not an unformulated
program based on expediency which shifts and vacillates. A firm
plan would indicate clearly to a career physician that he will not
close out his years of service as an assistant and that he does not
have to be a sycophant to succeed*
f. It must be plainly evident that a chain of command does
exist and that an individual physician does not have a personal
relationship with a superior which supersedes his relationship
to his supervisor.
5? Training*
a. It is agreed that professional, scientific, or other
pertinent postgraduate training is always essential to the individual
physician and can be an investment on behalf of the Agency's interests.
Such training should be a privilege planned and extended to an
individual when it is directly pertinent to his future utilization
in the Agency. It should not be regarded as a reward, bonus, or an
act to retain a person contemplating resignation or retirement*
b. The training an individual physician receives should be
determined only by the chief of a division in keeping with the
responsibilities and budget for his division. The primary relationship
in this matter should be of supervisor to employee, so that an orderly
sequence of authority follows. The Chief, Medical Staff should be
the ultimate approving authority.
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SUBJECT: A Career Plan for Medical Officers
c. Physicians selected and found suitable for intelligence
officer duties should be given additional Agency and external
training to increase their proficiency. Psychiatrists interested
in psychoanalytic training could be encouraged in that direction.
Occupational medicine specialty training could also be encouraged.
6. Salary and Promotion*
a. Although pay is not a primary consideration to medical
officers for retention as employees, it is an extremely important
inducement which may favorably influence the decision of a desirable
physician applicant. Agency and Medical Staff studies of salary schedules
have been reviewed by this Cormaittee.,
b. An equitable promotion plan, easily understood by all
medical officer applicants and employees, would be a worthy step
in delineating a career plan. The following graduated scale could
be considered, keeping in mind the possibility that for Board
eligible specialists two grades might be added and for Board qualified
15% of total salary might be added.
Grade Years of Creditable Service
GS-13 Entrance on duty
GS-lei Two
GS-15 Four
GS-16 Eight
GS-17 Twelve
GS-18 Sixteen
co An equitable salary incentive program would be another
measure which would give a career plan a practical meaning. It is
suggested the following graduated scale be considered: a 0.5%
increase in salary by grade for each year of professional experience
since the date of a physician's graduation from medical school and
an additional 0.5% increase for each year of satisfactory Agency
service up to a maximum of 15%.
d. In exceptional cases when the Medical Staff Career Service
Board votes unanimously in favor of an earlier than scheduled
promotion, an individual physician might be promoted to the next
higher grade. In the event a new Federal grade and salary scale
comes into being, an adjustment should be made that is proportional in
principle to the above outline.
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e. Although physicians, like others, are interested in
receiving more money, the obvious disparity in salaries of
lay-medical administrators and semi-professional technicians
compared to those of physicians produces a feeling in the
physician of "why should I stay here, since I am under paid
commensurately and the organization can overpay less qualified
people". When nonprofessional personnel are "over paid" commensurately,
the subtle question of status becomes important. To maintain an
appropriate balance of prestige and status, there must be a more
equitable distribution of grades and salaries, since most physicians
pay for their own professional education and carry all the
responsibility, while others have not made a similar investment in
terms of money and time nor are they permitted by law to accept
equal responsibility in a medical environment.
f. Other Federal medical officer positions have desirable fringe
benefits associated, such as: clinical opportunity, adequate
instruction, research possibilities, housing, etc. Yet competition
for recruitment and career service by this Agency is not with other
Federal institutions, but rather with private practice and industry
where even better economic opportunities exist.
g. Although it may be said that no physician has ever left the
Medical Staff primarily to gain more money, it is a fact that each
physician, who has separated from Agency employment, has increased
his earning power three or four fold within one to five years. This
is in sharp contrast generally to the fortunes of laymen who have
separated from the Medical Staff and the Agency; they are seldom able
to command as high a wage elsewhere. It is useless to offer a one
or two grade promotion to a physician who is about to leave, because
this could hardly deter him from his plans.
h. Another factor, not truly a pay matter, but nevertheless
an economic factor to a physician which deserves consideration is
the provision of medical malpractice insurance coverage by the Agency.
i. A provision whereby the Agency would pay dues and fees
connected with membership in pertinent professional, scientific, and
technical societies to a maximum of $200.00 per year would be an
expression of the desire of the Medical Staff to maintain high
professional standards.
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SUBJECT: A Career Plan for Medical Officers
7. Administration. Loyalty and command relationships are a two-
way mechanism. For example, there must be a thorough continuing under-
standing of budget and expenditure matters by each chief of division, whereby,
the chief of division controls all funds appropriated for his division.
A chief of division must have a basis upon which to plan any action involving
the use of the money he has previously requested up to the amount which has
actually been appropriated. Divisions must operate knowing what they have
"in the bank`. It should not be necessary for a division chief to argue
for the use of money that was previously justified and obtained through his
planning and support.
8. Summary.
a. It is believed that serious consideration, followed by
constructive Medical Staff action during the next few years, will
place the medical officer career program on a path which provides
for a continuation of the Medical Staff's evolving supporting role
with a planned future for a staff of medically qualified, intelligence-
oriented, experienced, and mature physicians. The substance of this
memorandum reflects observations and experiences which protect the
vested interests of all the physicians employed at this time and,
hopefully, are guidelines for future action. It indicates some means
by which the following conditions may be realized by the medical officers:
(1) The influx of the parvenu can be controlled in keeping
with a recent interpretation of a DDCI desire.
(2) The occurrence of expedient actions can be reduced to
a minimum or eliminated.
(3) The salary of an individual as a measure of his worth
to the Agency, in keeping with the opinions of contemporaries,
can become meaningful.
(4) A career with the Medical Staff would be a valued
experience.
9. Recommendations*
a. Take steps to obtain, by the following measures, an
accumulation of experiential data upon which to base future studies
and recommendations:
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SUBJECT: A Career Plan for Medical Officers
(1) Physician chiefs of division should be required to
interview in the future each medical officer contemplating
separation from employment.
(2) The Director of Personnel should be requested to
provide an analysis of the physician exit interviews which
have been collected, to include how many physicians have
separated for:
(a) reason of accepting a residency.
(b) purpose of entering private practice.
(c) undefined dissatisfaction.
(3) The Inspector General should be requested to provide
a similar analysis.
(4) The Chief, Medical Staff could review such records as
he may have on the same subject matter indicated under (2) above.
be Adopt, publish, and enforce a definite year-by-year-phased
medical officer career plan. A suggested plan is described in
paragraph 3 of this memorandum.
co By 1965, each division of the Medical Staff should have a
chief and deputy chief who is a career medical officer and they should
be assisted as appropriate by nonphysician, nursing, technical,
administrative, and clerical personnel. No division in the Medical
Staff should have a nonphysician chief.
Chief, Clinical Division, Medical Staff
25X1A9a
Chief, Operations Division, Medical Staff
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Date
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