State of the Category 2014 CAPT Scott Gaustad, USPHS Therapist Chief Professional Officer.

State of the Category 2014

CAPT Scott Gaustad, USPHSTherapist Chief Professional Officer

Category Day 2014

Welcome!2014 USPHS Scientific and Training Symposium

"Public Health Today: Prevention, Innovation, Progress.“Thank you Category Day Organizing Committee Chair CDR Damien Avery

Thank you CDR Tarri Randall and the TPAC Executive Committee.

Distinguished guests

State of the Category

• We are…

• We practice…

• Our accomplishments…

• Promotion…

• Readiness…

• What’s new…


Nation’s Rehabilitation Professionals Health Promotion and Disease Prevention Professionals

Audiologists

Occupational Therapists

Physical Therapists

Respiratory Therapists

Speech-Language Pathologists

162 licensed professionals

12 Federal Agencies

“Public Health Today: Prevention, Innovation, Progress”

Mission Statement:

In support of the PHS mission the Therapist Category:

• ADVANCES the Nation's health through innovative and cutting edge research, policy design, and health science,

• IMPLEMENTS evidenced-based research into clinical practice for the health and wellness of the Nation's underserved populations,

• EDUCATES the Nation to facilitate and encourage the adoption of healthy lifestyles to prevent disease and disability,

• PROVIDES efficacious and progressive intervention for those with disability and disease to maximize function and improve quality of life, and

• RESPONDS to national and international Public Health needs with highly trained and skilled officers.

Prevention, Innovation, Progress.“Public Health Today”:

Therapist Vision Statement:

• The Public Health Service Therapist Category will be a leader in in clinical and research rehabilitation science through:

• ENHANCING the Therapist Category’s leadership role in promoting the health and wellness of the Nation,

• EDUCATING public health leadership about the abilities of the Therapist Category on health promotion, disease prevention, wellness, rehabilitation and readiness response,

• PROMOTING Therapist Category professional development by enhancing their value in Public Health Service and the people we serve,

• ENCOURAGING advanced training, policy development, and research,

• ENGAGING in partnerships to meet public health challenges, and

• honoring the values, practices, and traditions of the Nation and the U.S. Public Health Service.


Gender

Female - 77 or 48%

Male - 85 or 52%

Diverse

American Indian or Alaskan Native - 16 or 10%

Asian or Pacific Islander - 6 or 4%

Black, not of Hispanic Origin – 10 or 6%

Hispanic - 7 or 4%

White, not of Hispanic Origin - 70 or 46%

Unknown - 53 or 33%

The Corps by Category

THER 162

ENG 409

DIET 103

HSO 1326

SCI 350

NURSE 1641

MED 851

DEN 280

EHO 354

PHARM 1239

VET 94

MED 16

NURSE 202

SCI 8

PHARM 18

ENG 2

VET 1

DEN 13

HSO 75

EHO 2

USCG 155

The Corps by Agency

SAMHSA 52

ATSDR 37

HRSA 192

IHS 2093

OS 172

ACF 8

JUSTICE 13

CDC 918

CMS 168

AHRQ 7

DOD TMA 254

USDA 20

NIH 296

INTERIOR 49

FDA 1033

PSC 35

DOD 7

DOC 19

USAMRMC 1

BOP 880

EPA 63

DHS 337

USCG 155

We practice… Corps

8737

880918

0168

49219

7254

631033

1922093

4913

296172

3552

120

0 500 1000 1500 2000 2500

ACFAHRQ

ATSDRBOPCDCCIA

CMSDHSDOCDOD

DOD/TMAEPAFDA

HRSAI.H.S.

INTERIORJUSTICE

NIHOS

PSCSAMHSA

USAMRMCUSDA

Total: 6809

Agency DEN DIET EHO ENG HSO MED NUR PHAR SCI THER VET Total

ACF 1 5 1 1 8

AHRQ 2 3 1 1 7 (-1)

ATSDR 20 2 6 1 1 6 1 37 (nc)

BOP 62 7 2 196 16 390 157 13 37 (+2) 868 (+12)

CDC 6 4 72 17 140 411 44 19 154 4 47 898 (+20)

CMS 3 1 2 52 9 58 32 4 7 (-1) 168(+13)

DHS 13 2 2 75 16 202 18 8 1 337

DHS (CG) 53 17 8 57 1 16 3 155

DOC 10 9 19(+1)

DOD 1 1 3 2 7 (nc)

DOD/TMA 2 1 4 116 18 46 12 43 11 1 254(-21)

EPA 15 34 8 1 2 3 63(-4)

FDA 5 26 82 68 186 48 157 372 71 6(+1) 12 1033(+43)

HRSA 5 7 5 2 86 19 44 16 4 5(-1) 192(-11)

IHS 132 44 94 233 282 133 526 566 6 77 (+2) 2093(-1)

INTER 12 22 8 3 2 1 1 49(+2)

JUSTICE 1 2 10 13(nc)

NIH 2 5 10 9 31 95 92 10 21 5 16 296(+1)

OS 2 3 7 10 68 16 38 14 6 5 3 172(+5)

PSC 1 10 2 8 1 12 1 35(-4)

SAMHSA 1 31 1 7 7 4 1 50(+2)

USAMRMC 1 1(nc)

USDA 1 3 6 1 2 1 6 20(-1)

Grand Total 280 (-18)

103 (-1)

354(-5)

409 (-23)

1326 (+8)

851(-5)

1641 (+17)

1239 (+44)

350 (+16)

162 (+2)

94(-1) 6809(+44)

Therapist Category - Where We Practice:

BOP37/23%

CDC, 4/2%

CMS, 7/4%

DHS, 3/2%

DOD TMA, 11/7%

FDA, 6/4%

HRSA, 5/3%

I.H.S77/48%

NIH, 5/3%

SAMHSA, 1/0.6%USDA,1/0.6%

Total: 162

Where We Practice…

Region 1

Region 2

Region 3

Region 4

Region 5

Region 6

Region 7

Region 8

Region 9

Region 10

0 5 10 15 20 25 30 35 40

8

2

27

28

5

27

5

938

13 Region 10: AK, ID, OR, WA

Region 9: AZ, CA, HI, NV, AS, MIslands, Guam

Region 8: CO, MT, ND, SD, UT, WY

Region 7: IA, KS, MO, NE

Region 6: AR, LA, NM, OK, TX

Region 5: IL, IN, MI, MN, OH, WI

Region 4: AL, FL, GA, KY, MS, NC, SC, TN

Region 3: DC, DE, MD, PA, VA, WV

Region 2: NY, NJ, PR, VI

Region 1: CT, ME, MA, NH, RI, VT

Where we work…

13

9

5

5

3827

28

2 8

27

Distribution by Corps and Category

We are… Corps

Therapist Category (6/2/2014)

Regular Active: 162

Regular Retired: 111

Reserve Retired: 11

284

Distribution by Rank – Corps

We are… Corps

We are…(Therapist vs Corps, T-Grade)

Therapist Category

O1 O2 O3 O4 O5 O6 O7 O8 O9

50/1%

211/3%

1097/16%

1968/29%1811/26%

1638/24%

34/.4%

16/.2%

O1

O2

O3

O4

O5

O6

O7

O8

O9

Regular/RR Corps

O2 O3 O4 O5 O6 O7

1/.6%

25/15%

40/25%

68/42%

28/17%

O2

O3

O4

O5

O6

Distribution by Rank – Category (T-grade) 2014 data

We are… Therapist

O-2 O-3 O-4 O-5 O-6 O-70

0.2

0.4

0.6

0.8

1

1.2

25

40

68

28

0

O-3O-4O-5O-6O-7O-2

We are…

O-2 O-3 O-4 O-5 O-6 O-70

0.2

0.4

0.6

0.8

1

1.2

25

40

68

28

O-3

O-4

O-5

O-6

O-2

2014 2013

24

47

62

26

10

10

20

30

40

50

60

70

O-2 O-3 O-4 O-5 O-6 O-7

O-3

O-4

O-5

O-6

O-7

We are… (Therapist vs Corps)

0-2 0-3 0-4 0-5 0-60.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

1%

15%

25%

42%

17%

3%

16%

29%

24% 24%

TherapyCorps

We are…

Information is only as good as that entered into online databases by officers.

Hail! Farewell! 2013-2014:

LT Lars Krusholm, PT - IHS

LT Michael Krok, PT - BOP

LT Raul Leija, PT - BOP

LT Melissa McGuinness, PT - IHS

LT Kayla Meeks, PT - IHS

LT John Burkart, AUD - IHS

LT Peter Arroyo, OT - BOP

LT Luis Millan, PT - IHS

LTjg Catherine Kaminski, OT - BOP

2013-2014:

RADM Penny Slade-Sawyer - OS

CAPT Fran Oakley - NIH

CAPT Georgia Johnson - CMS

Recruitment and Retention

Mentoring:The Therapist Category Mentoring program is designed to promote mentoring skills and to assist with the integration of officers and civilian therapists into the US Public Health Service. Junior levels of GS (5-7) and CO (O3 and below) are eligible to participate as mentorees. Eligible mentors are those persons at or above the GS-8 level for civil service or a rank of O4 for commissioned officers.

Therapist Category: 162 officers (26 O-3 and below)

- 68 mentors (42%)

- 8 mentorees (5%)


Benefits of Mentoring:

- Enhance strategic business/professional initiatives- Encourage retention- Improve productivity- Break down the "silo" mentality- Elevate knowledge transfer - Enhance professional development- Link employees with valuable knowledge - Internal experts for professional development- Creating a mentoring culture, which promotes individual

employee growth and development


Total = 162

< =5 5.1 - 10 10.1 - 15 15.1 - 20 20.1 - 25 25.1 - 300

5

10

15

20

25

30

35

40

45

34 34

30

39 (24%)

12 (7%) 13 (8%)

Years of Service – 2014

Recruitment and RetentionRetirement Credit

< 5 5.1-10 10.1-15 15.1-20 20.1-25 25.1-300

5

10

15

20

25

30

35

40

31 30

33

37

18

10

Year s of Service – 2014 Total = 162Years of Service – 2013 Total = 161

< =5 5.1 - 10 10.1 - 15 15.1 - 20 20.1 - 25 25.1 - 300

5

10

15

20

25

30

35

40

45

34 34

30

39

12 13


O3 O4 O5 O3 O4 O5 O6 O4 O5 O6 O5 O6 O7Rank O3 Rank O4 Rank O5 Rank O6 Rank

O7

0

5

10

15

20

25

34

3

1

9

19

56

2221

4

13

1

Officers by Rank and Billet Grade

Nu

mb

er o

f O

ffic

ers

Most therapist officers with a rank of O4, 19 (18%) were in a billet grade of O5. The majority of officers with a rank of O5 reported either to be in a billet grade of O5, 22 (21%) or O6, 21 (20%).

2013 Data


When asked if therapist officers serve in a non-traditional billet or multidisciplinary assignment, 29 answered “Yes” of which 11 officers were Physical Therapists and 9 were Occupational Therapists. Eighty-five (85) (75%) officers answered “No”, of which 67 were Physical Therapists and 9 were Occupational Therapists

PT OT SLP AUD RT0

10

20

30

40

50

60

70

80

11 93 1 1

67

9

2 1 0

Nontraditional/Multidisciplinary Billet

Traditional Billet

Discipline

Nu

mb

er o

f th

erap

ist

offi

cers

2013 Data


2013 Data

Strongly Disagree/Disagree

Neutral Stronly Agree/Agree0

10

20

30

40

50

60

3 1

1611

14

137

57

Billet Increase

Billet Decrease

Billet remained the same

Nu

mb

er o

f O

fiic

ers

One officer whose billet grade was increased felt neutral about the change and the remaining 16 officers were satisfied with the change. Thirteen officers (17%) whose billet grade remained the same were also dissatisfied with their billet grade while 73% of officers whose grade didn’t change reported they were satisfied. In addition, four officers had their billet grade reduced but still reported being satisfied with their billet grade

Recruitment and Retention2013 Data

Factors leading therapist officers to consider early separation from the Commissioned Corps, comparing officers with <5 years of retirement credit to officers with >15 years of retirement credit.

Factors leading therapist officers to consider early separation from the Commissioned Corps, comparing officers with 5-15 years of retirement credit to officers with >15 years of retirement credit.

Recruitment and Retention2013 Data

Therapist officer agreement with statements pertaining to specific features of Commissioned Corps services (N=115).

Accomplishments: Activities in 13-14 TPAC year

• 2016 PY Benchmarks review• New TPAC Chair members/

sub/committee chairs • APAN

• National Prevention Strategy• Continued development of Direct Access• Category Deployment Guideline• Evolving Mentorship Program• Strategic Growth Subcommittee business

plan and career planning • Call to Active Duty process/Appointment

Board• Academic Recruitment Project

Continuing activities

• Retirement recognition• Category, Responder Awards• AMSUS – Rehab Program • Journal Club • Vacancy list – Recruitment • Promotion preparation guide,

credentials review guide• Category roster and profile• Web page• Listserv• PAC P&P and Model Charter

implementation • Fit for Duty – Fit for Life articles• Mentoring!• Promoting Physical Activity Guidelines

We’ve Accomplished…!

Individual accomplishments – Awards• PHS Awards

– Commendation Medal

– Achievement Medals

– Crisis Response Service Award

• COA recognition

• AMSUS recognition (P.T. and O.T.)

• Agency and duty station recognition

– Directors awards, employee of the quarter, month

• National Recognition - AOTA

• Category awards - luncheon


Individual accomplishments – training• Advanced degrees (DPT)/certificates

• Women’s Health, Vestibular Rehab

• Earned Board Specialties

OCS, GCS, EMG/NCV, CWS, CLT, CSCS

• Participated in professional training

professional conferences/CEUs, readiness and response, OBC, and MOC


Service• COA office, local and national• Healthy lifestyles, health fairs, PT Month activities• Community service • Recruiting• Expert on grant reviews• CC Ensemble and Choir

Clinical Programs• EMG/NCV• Bariatrics, diabetes• Wound care, Spinal Cord• Student education • Journal Club• Health and Wellness!


Presentations• Agency/Local • Professional societies• 2013 COF symposium• CEU courses

Publications• The Hearing Journal• Journal of the Acoustical Society of America• Journal of the American Academy of Audiology• Military Medicine (AMSUS) • Physical and Occupational Therapy in Pediatrics• American Journal of Occupational Therapy• Pediatric Physical Therapy• Journal of Orthopedic and Sports Physical Therapy• Book chapters


2014 Category Awards:

William Fromherz Award: CAPT Michaele Smith

Therapist of the Year: CDR Matthew Armentano

Junior Officer of the Year: LT Chandra Preator

Josef Hoog Award: CAPT David Byrne

Professional DevelopmentPromotion

Recognition

• Temporary Promotions (PY ’13)

4* @ O-6, 10 @ O-5, 4 @ O-4

* 1 EPP

• Permanent Promotions (PY ’13)

3 @ O-5, 4 @ O-4, 2 @ O-3

Professional Development Promotion

2005 2006 2007 2008 2009 2010 2011 2012 20130%

20%

40%

60%

80%

100%

82%78% 80% 82%

88% 86%90%

100%

80%

38%42%

46% 46%41%

44% 42% 41% 41%

25%30%

33%36%

29% 27% 25% 25%22%

Success rates by rank

T04

T05

T06

Promotion Year

% S

ucce

ssfu

l


2004 2005 2006 2007 2008 2009 2010 2011 2012 201320

30

40

50

60

70

80

90

100T O-4

range

Series2

avg

cut

Promotion Year

Tot

al S

core


2004 2005 2006 2007 2008 2009 2010 2011 2012 201320

30

40

50

60

70

80

90

100

T O-5

range

Series2

avg

cut

Promotion Year

Tot

al S

core


2004 2005 2006 2007 2008 2009 2010 2011 2012 201320

30

40

50

60

70

80

90

100T O-6

range

Series2

avg

cut

Promotion Year

Tot

al S

core

Professional Development Promotion - Precepts

1) Performance (40% of overall score)

2) Education, Training, and Professional Development (20% of overall score)

3) Career Progression and Potential (25% of overall score)

4) Characteristics of Career Officer & Service to the Corps (15% of overall score)

5) Response Readiness (0% of overall score, not scored by the promotion board). Response readiness is still an administrative check used for promotion. Officers who fail to meet and maintain basic readiness will not be promoted


Precept 1 Precept 2 Precept 3 Precept 40

10

20

30

40

50

60

70

80

90

20122013

Pro-fes-sional Devel-op-ment

Ca-reer Pro-gres-sion

Officership

T-O4

Successful Average

Performance



10

20

30

40

50

60

70

80

90

20122013

Pro-fes-sional De-vel-op-ment

Ca-reer Pro-gres-sion

Of-fi-cership

T-O5

Succes

sful Average

Performance



68

70

72

74

76

78

80

82

84

86

20122013

Pro-fes-sional De-vel-op-ment

Career Pro-gres-sion

Performance

T-O6

Succes

sful Average

Officership

Professional Development Promotion Preparation

General feedback to all officers:

• Current and accurately formatted CVs are very important. • Check Therapist Category for current year Promotion

Benchmarks• Use recommended CV format on website• Awards• Acknowledge post-graduate education and academic

achievements• Acknowledge and include post-graduate work in eOPF


General feedback to all officers:

• Career counseling encouraged but not required for any officer not promoted. Officers are free to choose who performs the counseling.

• Category career counseling by CPO or designee required for officers ranked in the lowest decile and lowest quartile X3 years. This must be documented in OPF.

• Officers ranked in lowest decile x3 years referred to retention review board.

• Officers not meeting readiness standards receive automatic not recommend and referred to review board.


General feedback to all officers

• Review your eOPF to see if you can EASILY locate information that addresses ALL promotion benchmarks.

• List the contact hours for continuing education• Please consider the fax machine you are using• Common issues included missing or out-of-date

documents, 100% under the officer’s influence; CVs, Officer Statements, Continuing Education List.

• Verify that documents are complete, accurate, error free, and legible after they are faxed to the eOPF.


• Comments on the score sheet provide insight into areas on which to focus to improve your performance/ scores for next year

• At least 2 board members must check box for strength/ suggestion to appear

• All free text comments appear

60


ReadinessDecember 31• If ready – earn 0 points on readiness precept (PY-14)• If not – automatic not recommend for promotion

March 31• Part of administrative check along with licensure and other issues• If ready – stay on rank order list• If not – removed from rank order list, even if scored well enough by

promotion board to be promoted

Strategic Growth/Development Promotion Preparation

Rehab Director

Agency Director

Other Post-Graduate

Capstone Education

Officer Mid-Level

Course (OMC)

JODC Advanced Spine

Masters in Business

Administration

Officer Basic

Course (OBC)

Kersey NMSE

Masters in Public

Health

USPHS Therapy Category Career Path Guide

Non-traditional positionsHealth Insurance specialists (O4-O6)

within CMSDirector of Professional Services

or Quality Management (both O-6) within IHS

Administrative

Research Therapist I

Therapist

Deputy ChiefTherapist

Chief Therapist II

Chief Therapist I

Education/TrainingService Related Non-Service Related

Research

Staff Therapist

CO-STEPTraining Therapist

Clinical CoordinatorEducation

Coordinator

Clinical Expert

ClinicalSpecialist

Senior Therapist

Chief Professional Officer

Clinical

Strategic Growth/Development Productivity

USPHS Provider Productivity benchmarks for Occupational and Physical Therapists:

Occupational and Physical Therapy clinicians within the USPHS work in various practice settings and this document represents an initial attempt to establish productivity benchmarks. These benchmarks should be used to gauge and improve productivity and are not intended to represent an absolute standard for all providers. The benchmarks are established utilizing productivity data from the US Army and the private sector1,2.

Unit of Measure: Provider productivity is measured utilizing relative value units (RVU’s).

Two major components of the relative value unit are: 1) personnel time associated with the activity2) other direct and appropriate indirect department resources used in

providing the activity.- 15 minutes has been established as the least increment of time for which a unit of

service (e.g., evaluation, therapeutic, or patient educational activity) can occur

- The unit of service is a modality - Activity is used to establish the basic relative value unit of 1.0.

Readiness and Response

3/31/12

Readiness and Deployment

Basic - 146 or 90%

Exempt - 8 or 5%

Not Qualified - 8 or 5% (March 31st) 35 or 22% (May 31st)

n = 162 (last reported number)March 31, 2014

Basic +Exempt = 95% (1st – Copper!)

May 31, 2014 Report: 78%


Extinct after 12/31/2014


Recent Deployments:• Field-based training

• Mariana Islands - Saipan

• CHASM– IHS

Transformation – Direct Access

Current Priorities

• Direct Access – continued implementation of DA. Retiree pay completed. Active duty pay transition ongoing.– Now primary means to enter some readiness info, but be

familiar with all data fields.

Professional Development Billets

Questions:

• personnel order in eOPF “change of assignment”

• receipt of “individual position number” DA number

• current Assignment and Assignment History• Current assignment – DA position and billet equivalent grade

• Assignment History - DA Billet System Position Assignment

• Stated grade is the pay grade of the officer – not position

Professional DevelopmentPromotion: BCS

Number of Therapists at the time of BCS: 118

Number of O5 billets before BCS: 31 (26%)

Number of O5 billets after BCS: 40 (34%)

Number of O6 billets before BCS: 37 (31%)

Number of O6 billets after BCS: 34 (29%)

Total O5 & O6% before BCS: 58%

Total O5 & O6% after BCS: 63% (+5%)


BOP:

Total at time of BCS: 33

Before BCS

Number of O5: 9 (27%)


Total % O5 and O6: 45

After BCS



Total % O5 and O6: 45 (nc)

IHS:

Total at time of BCS: 63

Before BCS



Total % O5 and O6: 62

After BCS


Number of O6: 21(33%)

Total % O5 and O6: 63 (+2)


BOP

O5 B

efore

BCS

O5 A

fter B

CS

O6 B

efore

BCS

O6 A

fter B

CS0

2

4

6

8

10

12

BOP

IHS

O5 Befo

re BCS

O5 afte

r BCS

O6 befo

re BCS

O6 afte

r BCS

0

5

10

15

20

25

Column1

Information Management:New Policies

DCCPR Issuances

• Uniform Wear - ODU (January 1, 2015)• Voluntary Retirement - CC384.02 • Protected Communications - CCD 121.06• Minimum GPA - PPM 14-001 (2.5 to 2.8)• Ready Reserve Officers - POM 14-002• Amendment to Uniform Wear - PPM 14-002• Uniforms and Appearance - CC412.01• 2015 Promotion Benchmarks

Information Management:Policies in Development

DCCPR Issuances in process: • Administrative and Disciplinary Actions • Allotments • Child Support/Alimony Garnishment Orders • Consolidated Special Pays • Deployment Readiness • Details (Blanket) • Domestic/Family Neglect; Violence, Abuse

and Treatment • Uniforms - Discipline • APFT

• Equal Opportunity • Force Management (Assimilation

Program) • Former Spouse Payments from Retired

Pay • Leave • Physical Training Uniform • Political Activities • Promotions Directive • Protected Communications • Travel and Transportation Allowances

Health Care Reform

Patient Protection and Affordable Care Act (ACA)

• Sec. 5209. Elimination Of Cap On Commissioned Corps.

• Sec. 5210. Establishing A Ready Reserve Corps - pending

• Sec. 203. Commissioned Corps And Ready Reserve• Sec. 5315. United States Public Health Sciences

Track – pending• Wellness, Prevention and Chronic Care management

is a priority

The future…

• Direct Access Active Duty Pay• Health Care Reform • Review of CC operational

components – Readiness • CAD Process• Five Pillars – 2016 Benchmarks• National Prevention Strategy• Best Practice Guidelines• Standardized position descriptions• Credentialing and Privileging • ICD-10• Career Development/Career

Progression mapping

Surgeon General Initiatives• Childhood Overweight and

Obesity Prevention Initiative

• National Prevention Strategy

• Women’s Health Issues

• A Healthy and Fit Nation

• Walking Call to Action

Stay Engaged…!

http://www.surgeongeneral.gov/%20http:/www.surgeongeneral.gov/initiatives/tobacco/index.html

http://www.surgeongeneral.gov/initiatives/walking/index.html

http://www.surgeongeneral.gov/initiatives/breastfeeding/index.html

“The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.” Eleanor Roosevelt

“The most important thing in life is to live your life for something more important than your life.”

Anonymous

CAPT (Ret) Judith Bell Krotoski

CAPT (Ret) Jonathan Spry

CAPT (Ret) John “Jack” Echternach

August 16, 2014 – Vining, MNrunforthemelon.com

State of the Category 2014 CAPT Scott Gaustad, USPHS Therapist Chief Professional Officer.

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Transcript of State of the Category 2014 CAPT Scott Gaustad, USPHS Therapist Chief Professional Officer.