by Celia Hooper

It's been a long time coming, but NIH is finally getting two key authorities to raise salary ceilings to help attract and retain top clinicians and other biomedical researchers. The newly approved authorities -- which have been wending their way through the executive branch for months, or years, depending on how you count -- are the Senior Biomedical Research Service (SBRS) and Title 38.

SBRS will be a new appointment category for outstanding scientists who do biomedical research or who evaluate clinical research. To be eligible for SBRS, scientists must be at or above the GS-15 level. SBRS personnel may earn a maximum salary equal to Executive Level I (or Cabinet Secretary's pay, currently $148,400), but the bulk of appointments will initially start closer to the lower end of the scale, now $67,941.

Title 38 will allow key medical staff (at the GS-13 level and above) who provide patient care in certain subspecialty areas to earn as much as $200,000 per year -- given they qualify for the maximum salary add-ons in all categories and provided the Deputy Assistant Secretary of Health approves pay above the Executive Level I level.

Deciphering Title 38
Calling Title 38 "the most important personnel structure for physicians [at NIH] in the last 20 years," Associate Director for Clinical Research John Gallin says the measure "should go a long way toward improving morale and helping us recruit physicians involved in patient care at the Clinical Center." Another consequence may be that Clinical Center services that have been contracted out to private firms that could pay doctors more than NIH may return to being provided by staff physicians, says Gallin, who, along with Director of Human Resources Steve Benowitz, began pursuing Title 38 authority for NIH last spring.

Director of the Office of Equal Opportunity Naomi Churchill also believes that Title 38 may bolster efforts to attract top female and minority physicians, saying the authorization "is perceived as really opening some doors to make it easier for salaries to be negotiated."

An important feature of the Physician Specialty Pay (PSP) provided by Title 38 is that once a doctor has 15 years of Public Health Service (PHS) experience, his or her total pay, including all the PSP salary add-ons, are counted in determining the "high three" -- the three highest-pay years on which retirement benefits are based. Gallin says the good news is that with PSP, the total package counts toward retirement, unlike bonuses that can raise pay for Commissioned Corps officers. But he adds, "The bad news is that you have to be in the Civil Service for 15 years to get it [the higher retirement pay]." A decision on whether prior Commissioned Corps service can be counted toward the 15-year PHS service requirement is pending at the Office of Personnel Management.

Restrictive definitions of who is covered under Title 38 and who is eligible for various categories of PSP suggest that fewer than 250 doctors will be transferring to the new pay program or joining NIH under the new plan. Individual calculations on whether it will be more lucrative than current pay systems may require both higher math and an insider's knowledge of government benefits. Physicians with specific questions about PSP are advised to contact the personnel officers at their institutes, centers or divisions. However, in general, physicians who have more years of experience and who are in the most scarce specialty areas are most likely to realize salary increases under Title 38.

Gallin points out that neither Title 38 authority nor SBRS bring with them any increase in the number of staff that NIH may have at GS-14-and-above pay levels. A cap on the number of these higher-paid positions at NIH has sharply restricted promotions and hiring at the upper echelons of scientists over the past year. "Initially, Title 38 will be used to recruit and retain our needed clinical staff," says Gallin. "Conversion of Commissioned Corps staff to Civil Service positions will be allowed but will be restricted by the availability of positions at the GS-14 level and above." The exact procedures for proposing and approving doctors for PSP are still being worked out.

The Scoop on SBRS
SBRS received final sign-off from the Office of Management and Budget (OMB) as The NIH Catalyst went to press. Ultimately, NIH hopes to get 383 of the 500 SBRS slots that have been granted to the Department of Health and Human Services (HHS). By agreement with PHS and OMB, these will be used primarily for recruitment and retention of Civil Service scientists, with the majority of appointments at the lower end of the pay scale.

Until recently, NIH's pursuit of SBRS seemed like a Sisyphean saga. Shortly after the Civil Service Reform Act of 1978 spawned the Senior Executive Service (SES), the NIH Board of Scientific Directors appointed a Committee on Pay and Personnel Systems in Intramural Research. In 1984, that committee concluded that SES was not ideally suited for NIH and what was needed was a system more akin to personnel systems found in academia -- a scheme with a tenure system; promotions based on scientific productivity; portable, vested retirement; and salaries based on the pay in comparable academic institutions. The panel's proposal made it no further than HHS despite multiple attempts to jostle it forward. Modest success came in 1990, when the late Rep. Silvio O. Conte (R-Mass.) managed to get SBRS tacked on to an urgent appropriations bill. "If it had not been for Conte's interest in NIH, we might never have gotten this authority," recalls Benowitz. "Persistence pays off." The official name for the SBRS is now the Silvio O. Conte Senior Biomedical Research Service.

The struggle since 1990 has been to translate the congressional authorization into a functional program. "Originally, we wanted a lot more flexibility than this [approved version of SBRS] gives us," says Benowitz. "We wanted to be able to let Commissioned Officers enter the SBRS and transfer their time. This does give us a better system for performance appraisal, based on the Board of Scientific Counselor's reviews every three to four years -- evaluation tied entirely to the science a lab produces." Benowitz notes that "people have gotten pretty cynical" about SBRS. "It wasn't that it took 10 years to get the authority -- although that contributed to it -- but because it has been four years since the law passed, and we're still not using it," he says.

In addition to higher salaries, SBRS offers the benefit of "portable" retirement benefits similar to those in academia, but only if a scientist is recruited to SBRS from outside the government. Benowitz says this feature "should appeal to academics who may not want to stay in the government for 20 years." Some senior scientists now in the Commissioned Corps or other employment systems may profit by retiring and starting a second career in SBRS, but Benowitz notes the financial pros and cons will vary for each individual. Members of the SBRS are not eligible for Physicians' Comparability Allowance, performance awards, or other bonuses or awards for recruitment, relocation, or retention. Unlike Title 38, SBRS does not require that members spend 15 years before counting their new salaries toward the "high three" pay years used to fix retirement benefits. PHS recently approved an SBRS credentialing/policy committee, which is expected to begin work quickly, now that OMB's final approval has been received.

Although they were a long time coming, Benowitz notes that Title 38 and SBRS authorities are particularly welcome at this point -- just as a more-than-year-long hiring freeze is being lifted. "Institutes have not been able to go out and recruit senior scientists for awhile. We have a number of Scientific Directors' positions open, plus a number of Lab Chiefs'," Benowitz says. "The need was there, and now the opportunity is there to use the new authorities."

BOX - Title 38 at a Glance
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