When you think of being commissioned into a uniformed service, the U.S. Public Health Service (USPHS) may not be the first service that comes to mind. However, as one of the seven uniformed services, USPHS gives physical therapists (PTs) the chance to fill public health leadership and service roles within the nation's federal government agencies and programs.
LT Heidi Fisher, PT, USPHS, joined USPHS as a commissioned officer in 2005. Currently working within the Tuba City Regional Health Care Corporation, she serves the Indian Health Service (IHS) in Arizona. When a corps officer from the Winslow IHS came in uniform to teach a seminar at her PT school, Fisher began researching more about physical therapy opportunities in the USPHS. Later in her PT program, one of her clinical rotations was at the Northern Navajo Medical Center in Shiprock, New Mexico, working with IHS on the Navajo reservation. "I was very impressed with the caliber of the officers I had met and worked with on my internship, providing me with built-in role models of the quality of PT I'd like to be,"
Fisher said. "I felt that the USPHS has a strong and positive mission to bring health care to underserved individuals and to act as leaders in the advancement of health care." The USPHS began as the Marine Hospital Service, part of a 1798 act establishing a federal system to provide health care and hospitals for America's sick and disabled seamen. Over time, its responsibilities expanded to include additional public health responsibilities such as quarantine and medical inspection of immigrants. Now called the Public Health Service, it is part of the Department of Health and Human Services. IHS is one of the eight operating divisions in the department.
Fisher selected her career path due to a desire to use her broad-based interest in neurology and orthopedics physical therapy in a general-practice setting. "The military-equivalent benefits, including retirement and health care as well as the possibility of loan repayment through the Indian Health Service, were an added incentive, although not my primary motivation for enlisting," she says.
Serving With Pride
IHS serves members of the 562 federally recognized American Indian or Alaska Native tribes, approximately 1.9 million people. Most facilities are located in isolated stations, some in the Bureau of Prisons, and others in research. "Working for the federal government, we are able to be licensed in any state, so there are fewer difficulties when changes are made in duty station," Fisher said.
LCDR Alicia Souvignier, PT, DPT, GCS, USPHS, APTA member and physical therapist for IHS, enjoys the opportunity to provide the much-needed services to the remote areas. "I enjoy where I work, whether it is in a federal prison or out in an American Indian community, because I feel I am providing a needed service that might not otherwise be available," Souvignier said. "I believe in what the Commissioned Corps stands for, and this gives me the pride to come to work every day and give my all."
The IHS area where Fisher works serves the western part of the Navajo reservation or about 40,000 beneficiaries. Her facility provides inpatient and outpatient services from acute to subacute to chronic across multiple areas including pediatric, geriatric, vestibular, neurological, and orthopedic. "Being in a rural, lower-socioeconomic setting, we have a high no-show rate for scheduled patients, often due to gas prices, lack of transportation, or poor road conditions," Fisher said. "For this reason, it is hard to abolish the walk-in or urgent care services completely. Many of our patients come from 30 to 80 miles away, so we try to get all of their health care taken care of in one trip."
In her work with IHS, Fisher has developed a close peer-working relationship with physicians and other health care practitioners. "We participate in daily rounds with the orthopedic surgeons and are well-respected as the musculoskeletal experts at the hospital, frequently called for consultations about patients," Fisher said.
USPHS members can be deployed in times of need. Fisher has been in the rotation to deploy several times but has not been called or has been deemed "mission critical" to help maintain services at her local duty station. Her supervisor was called up last year for the Texas hurricanes. Other USPHS officials were sent to the World Trade Center on September 11, 2001, as part of the relief efforts, and many were deployed in the aftermath of hurricanes Katrina, Rita, and Wilma in 2005.
For Fisher, Souvignier and other PTs working for USPHS, serving their country—and their patients—is all in a day's work.
Perspectives for New Professionals of the American Physical Therapy Association, Supplement to Physical Therapy, September 2009, pages 27-28