In 1968-70, I served 2 years as a US Public Health Service commissioned officer, stationed at the US Marine Hospital in Galveston. Like all medical graduates of that era, I had a draft obligation to fulfill and was very happy to get the USPHS commission as it satisfied my draft board…as long as I served with the Marine Hospital Service. I had originally gotten interested in a PHS commission while in medical school as I wanted to be a Peace Corps staff physician (take care of volunteers) and “see the world.” But when Vietnam heated up, political pressure dictated that a restricted list of job choices had to be offered to incoming officers with a draft obligation, so I ended up in the Marine Hospital Service branch of the PHS for 2 years.
My observation was that, at least in that era, the PHS was generally attracting a pretty high caliber of physician. ALL male medical school graduates HAD to serve 2 years in SOME military or PHS position in that time, and of the available choices, the PHS was quite an attractive one. I felt very fortunate to be able to get in. The biggest obstacle to the quality of care, however, was a chronic budgetary shortage…I think the government was angling toward trying to get out from under its obligation even then…and the physical facilities and equipment we had to work with were, to put it gently, “challenged.” Most of the Marine Hospitals dated from the very early 20th Century (or earlier) and were woefully out of date. Most of our ward facilities were old fashioned “open wards” which was pretty antiquated even in the '60’s.
We were busy though! As I recall, just about anyone with a Z card was eligible for free care. There were some restrictions if it had been too many days since one had been “under articles,” but for the most part we provided comprehensive care to Merchant Mariners whether taken ill at sea or ashore. My recall is a bit shaky about the details of this, but we did have a clientele of “retired” merchant mariners who hadn’t sailed in a long time. I seem to recall that that magic qualifier was that IF you’d been declared Permanently NFFSD (not fit for sea duty) and the reason had ANY connection to your maritime service, then you could be labelled PNFFSD & Eligible For Chronic Care (for everything, not just your service connected problem). Something like that. I know I had a lot of old timers in my office practice when I worked the outpatient clinic at Galveston and some of them hadn’t been to sea for a long time.
One other little known service we provided to the Merchant Marine (of other nations as well), was a radio medical advisory service to ships at sea. Our OD was responsible for fielding calls from the Coast Guard, and also occasionally from Mackey Radio (who had a station on the Texas Gulf Coast) who wanted to patch us into a radio-telephone call from a vessel as sea whose (usually) skipper wanted advice on how to handle some sickness or injury in a crew member. Our Hospital Director when I was at Galveston was also the author of the USPHS published book: “The Ship’s Medicine Chest & Medical Care At Sea,” which I think used to be in the skipper’s library on a lot of vessels.
I don’t recall exactly how they were qualified, but licensed commercial fishermen were included in our eligible list at that time as well. I THINK perhaps that was a relatively new extension of the benefit. But I know we had a lot of Gulf Shrimpers, who, in those days, were mostly Cajuns…that industry to later be taken over by Asian immigrants for the most part. We also took care of a lot of military personnel in the outpatient clinic. Rarely, we’d have military people hospitalized, but only on an emergency basis usually as they’d get transferred to their own nearest service hospital (in San Antonio or Corpus Christi). Coast Guardsman, however, were a primary responsibility for us for all care.
The USPHS essentially served as a medical corps for the Coast Guard and had commissioned officers assigned directly to some CG facilities and vessels on offshore duty. PHS officers also served on NOAA ships when away from the US. Our pool of 2 yr. Gnl. Medical Officers at Galveston always had 1 or 2 guys away on rotation to a CG or NOAA cruise. At Galveston, we had Coast Guard sick-call 6 mornings a week, year-round. USCG Base Galveston was a pretty sizable base at that time with two 210’ Med. Endurance Cutters and two Bouy Tenders stationed there full time.
The Marine Hospital Service has a very long history and was actually created in 1798. It was essentially the nucleus around which the USPHS as we know it today was formed. At one time MOST of the major seaports of the US (including the inland port of Louisville, KY) had large, busy Marine Hospitals. You can look up the history if you’re interested. The original funding basis was that it was funded by an insurance scheme where all merchant mariners contributed out of their pay. As I recall it was supposedly the first health insurance scheme, public or private, known in the United States.