PART II-POPULATION GROUPS

A. Criteria

Population groups within particular geographic areas will be designated if the following criteria are met: (a) Members of the population group do not have access to the optometric resources within the area (or in contiguous areas) because of nonphysical access barriers (such as economic or cultural barriers). (b) The estimated supply of optometric services available to the members of the population group (as determined under paragraph B.3 of Part I of this Appendix) is less the estimated number of visits required by that group (as determined under paragraph B.2 of Part I of this Appendix), and the amount of the difference, that is, the computed shortage, is at least 1,500 visits.

B. Determination of Degree of Shortage The degree of shortage of a given population group will be determined in the same way as described for areas in paragraph C of Part I of this Appendix.

APPENDIX E-CRITERIA FOR DESIGNATION OF AREAS HAVING SHORTAGES OF PODIATRIC MANPOWER

PART I-GEOGRAPHIC AREAS

A. Criteria

A geographic area will be designated as having a shortage of podiatric manpower if the following three criteria are met: 1. The area is a rational area for the delivery of podiatric services. 2. The area's ratio of population to foot care practitioners is at least 28,000:1, and the computed podiatrist shortage to meet this ratio is at least 0.5, that is, rounds off to a need for at least one additional podiatrist. 3. Podiatric manpower in contiguous areas are overutilized, excessively distant, or inaccessible to the population of the area under consideration.

B. Methodology

In determining whether an area meets the criteria established by paragraph A of this Part, the following methodology will be used:

1. Rational Areas for the Delivery of Podiatric Services. (a) The following areas will be considered rational areas for the delivery of podiatric services: (i) A county or a group of contiguous counties whose population centers are within 40 minutes travel time of each other. (ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market or transportation patterns or other factors has limited access to contiguous area resources, as measured generally by a travel time of greater than 40 minutes

from its population center to such re

sources.

(b) The following distances will be used to estimate distances corresponding to 40 minutes travel time: (1) Under normal conditions with primary roads available: 30 miles. (ii) In mountainous terrain or in areas with only secondary roads available: 20 miles. (iii) In flat areas or in areas connected by interstate highways: 35 miles. Within inner portions of metropolitan areas, the large variations in the scope of public transportation systems and traffic conditions do not permit standard mileage figures to be specified. In these areas information on the public transportation system will be used to determine the area corresponding to 40 minutes travel time.

2. Population Count. The population count used will be the total permanent resident civilian population of the area, excluding inmates of institutions, adjusted by the following formula to take into account the differing utilization rates of podiatric services by different age groups within the population.

Adjusted

population=total population x(1+2.2x(percent of population 65 and over) x 0.44x(percent of population under 17)).

3. Counting of Foot Care Practitioners. (a) All podiatrists providing patient care will be counted. However, in order to take into ac count productivity differences in podiatric practices associated with the age of the podiatrists, the following formula will be utilized:

Number of FTE podiatrists = 1.0x(podiatrists under age 55)+0.8\(podiatrists age 55 and over).

(b) In order to take into account the fact that orthopedic surgeons and general and family practitioners devote a percentage of their time to foot care, the total available foot care practitioners will be computed as follows:

Number of foot care practitioners=number of FTE podiatrists +0.15×(number of orthopedic surgeons)+0.02×(number of general and family practitioners).

4. Determination of Size of Shortage. Size of shortage (in number of FTE podiatrists) will be computed as follows: Podiatrist shortage = adjusted population/ 28,000 number of foot care practitioners.

5. Contiguous Area Considerations. Podiatric manpower in areas contiguous to an area being considered for designation will be considered excessively distant, overutilized or inaccessible to the population of the area under consideration if one of the following conditions prevails in each contiguous area:

(a) Podiatric manpower in the contiguous area are more than 40 minutes travel time from the center of the area being considered for designation. (b) Population-to-foot care practitioner ratios in contiguous areas are in excess of 20,000:1, indicating that contiguous area podiatric manpower cannot be expected to help alleviate the shortage situation in the area for which designation is requested. (c) Podiatric manpower in contiguous areas are inaccessible to the population of the area under consideration because of specified access barriers (such as economic or cultural barriers).

C. Determination of Degree of Shortage

The degree of shortage of a given geographic area, designated as having a shortage of podiatric manpower, will be determined using the following procedure:

1. Grouping of Areas. Designated areas will first be assigned to groups, based on the ratio (R) of adjusted population to number of foot care practitioners, as follows: Group 1-Areas with no foot care practitioners or areas with R<50,000 and no podiatrists. Group 2-Other areas with R<50,000. Group 3-Areas with 50,000 R<28,000. All group 1 areas will be assumed to have greater shortage than all group 2 areas, and all group 2 areas will be assumed to have greater shortage than all group 3 areas.

2. Relative Shortage within a Group. In comparing any two areas within each group as defined above, the area with the larger adjusted population will be assumed to have the greater shortage.

APPENDIX F-CRITERIA FOR DESIGNATION OF AREAS HAVING SHORTAGES OF PHARMACY MANPOWER

PART 1-GEOGRAPHIC AREAS

A. Criteria

A geographic area will be designated as having a shortage of pharmacy manpower if the following three criteria are met: 1. It is a rational area for the delivery of pharmacy services. 2. The number of pharmacists serving the area is less than the estimated requirement for pharmacists in the area, and the computed pharmacist shortage is at least .5, that is, rounds off to a need for at least one additional pharmacist. 3. Pharmacists in contiguous areas are overutilized or excessively distant from the population of the area under consideration.

B. Methodology

In determining whether an area meets the criteria established by paragraph A of this Part, the following methodology will be used:

1. Rational Areas for the Delivery of Pharmacy Services. (a) The following areas will

be considered rational areas for the delivery of pharmacy services: (i) A county, or a group of contiguous counties whose population centers are within 30 minutes travel time of each other; and (ii) A portion of a county, or an area made up of portions of more than one county, whose population, because of topography, market or transportion patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 30 minutes to such resources.

(b) The following distances will be used to estimate distances corresponding to 30 minutes travel time: (i) Under normal conditions with primary roads available: 20 miles. (ii) In mountainous terrain or in areas with only secondary roads available: 15 miles. (iii) In flat terrain or in areas connected by interstate highways: 25 miles. Within inner portions of metropolitan areas, the large variations in the scope of public transportation systems and traffic conditions do not permit standard mileage figures to be specified. In these areas, information on the public transportation system will be used to determine the area corresponding to 30 min

utes travel time.

2. Counting of Pharmacists. All active pharmacists within the area will be counted, except those engaged in teaching, administration, or pharmaceutical research.

3. Determination of Estimated Requirement for Pharmacists.

(a) Basic estimate. The basic estimated requirement for pharmacists will be calculat

ed as follows: Basic pharmacist

requirements=.15×(resident civilian population/1000)+.035×(total number of physicians engaged in patient care in the area).

(b) Adjusted estimate. For areas with less than 20,000 persons, an adjustment is made to the basic estimate to compensate for the lower expected productivity of small practices. Therefore,

(i) For areas with less than 20,000 persons: Estimated pharmacist requirement = (2 population/20,000)× basic pharmacist require

ment.

(ii) For areas with 20,000 or more persons: Estimated pharmacist requirement-basic pharmacist requirement.

4. Size of Shortage Computation. The size of the shortage will be computed as follows: Pharmacist shortage=estimated pharmacist requirement number of pharmacists availa

ble.

5. Contiguous Area Considerations. Pharmacists in areas contiguous to an area being considered for designation will be considered excessively distant or overutilized if either:

(a) Pharmacy manpower in contiguous areas are more than 30 minutes travel time from the center of the area under consideration, or

(b) The number of pharmacists in the contiguous area is less than or equal to the estimated requirement for pharmacists for the contiguous area (as computed above).

C. Determination of Degree of Shortage

The degree of shortage of a given geographic area, designated as having a shortage of pharmacy manpower, will be determined using the following procedure.

1. Grouping of Areas. Designated areas will first be assigned to groups, based on the ratio of the number of pharmacists available to the estimated pharmacist requirement, as follows:

Group 1-Areas with no pharmacists.

Group 2-Areas where the ratio of available pharmacists to pharmacists required is less than .5.

Group 3-Areas where the ratio of available pharmacists to pharmacists required is between .5 and 1.0.

All group 1 areas will be assumed to have a greater shortage than all group 2 areas, and all group 2 areas will be assumed to have a greater shortage than all group 3

areas.

2. Relative Shortage within a Group. In comparing any two areas within each group as defined above, the area with the larger computed shortage of pharmacists will be assumed to have the greater shortage. APPENDIX G-CRITERIA FOR THE DESIGNATION OF AREAS HAVING SHORTAGES OF VETERINARY MANPOWER

PART I-GEOGRAPHIC AREAS

A. Criteria for Food Animal Veterinary
Shortage

A geographic area will be designated as having a shortage of food animal veterinary manpower if the following three criteria are met:

1. It is a rational area for the delivery of veterinary services.

2. The ratio of veterinary livestock units to food animal veterinarians in the area is at least 10,000:1, and the computed food animal veterinary shortage to meet this ratio is at least .5, that is, rounds off to a need for at least one food animal veterinarian.

3. Food animal veterinarians in contiguous areas are overutilized or excessively distant from the population of the area under consideration.

B. Criteria for Companion Animal
Veterinary Shortage

A geographic area will be designated as having a shortage of companion animal veterinary manpower if the following three criteria are met:

1. It is a rational area for the delivery of veterinary services.

2. The ratio of resident civilian population to number of companion animal veterinarians in the area is at least 30,000:1 and the computed companion animal veterinary shortage to meet this ratio is at least .5, that is, rounds off to a need for at least one companion animal veterinarian.

3. Companion animal veterinarians in contiguous areas are overutilized or excessively distant from the population of the area under consideration.

C. Methodology for Determining Food Animal and Companion Animal Veterinary Manpower Shortages

In determining whether an area meets the criteria established by paragraphs A and B of this part, the following methodology will be used:

1. Rational Areas for the Delivery of Veterinary Services.

(a) The following areas will be considered rational areas for the delivery of veterinary services:

(i) A county, or a group of contiguous counties whose population centers are within 60 minutes travel time of each other. (ii) A portion of a county (or an area made up of portions of more than one county) which, because of topography, market or transportation patterns or other factors, has limited access to contiguous area resources, as measured generally by a travel time of greater than 60 minutes to such resources.

(b) The following distances will be used to estimate distances corresponding to 60 minutes travel time:

(i) Under normal conditions with primary roads available: 45 miles.

(ii) In mountainous terrain or in areas with only secondary roads available: 30 miles.

(iii) In flat terrain or in areas connected by interstate highways: 55 miles.

Within inner portions of metropolitan areas, the large variations in the scope of public transportation systems and traffic conditions do not permit standard mileage figures to be specified. In these areas information on the public transportation system will be used to determine the distance corresponding to 60 minutes travel time.

2. Determination of Number of Veterinary Livestock Units Requiring Care. Since various types of food animals require varying amounts of veterinary care. each type of animal has been assigned a weight indicating the amount of veterinary care it requires relative to that required by the milk cow. Those weights are used to compute the number of -- Veterinary Livestock Units" (VLU), for which veterinary care is required.

The VLU is computed as follows:

Veterinary Livestock Units (VLU)=(number of milk cows)

+ .2 × (number of other cattle and calves)

+ .05 × (number of hogs and pigs)

+ .05 x (number of sheep)

+ .002 × (number of poultry)

3. Counting of Food Animal Veterinarians. The number of food animal veterinarians is determined by weighting the number of veterinarians within each of several practice categories according to the average proportion of practice time in that category which is devoted to food animal veterinary care, as follows:

Number of Food Animal Veterinarians = (number of veterinarians in large animal practice, exclusively)

+ (number of veterinarians in bovine practice, exclusively)

+ (number of veterinarians in porcine practice, exclusively)

+ (number of veterinarians in poultry practice, exclusively)

+ .75 × (mixed practice veterinarians with greater than 50 percent of practice in large animal care)

+ .5 × (mixed practice veterinarians with approximately 50 percent of practice in large animal care)

+ .25 × (mixed practice veterinarians with less than 50 percent of practice in large animal care)

4. Counting of Companion Animal Veterinarians (that is, those who provide services for dogs, cats, horses, and any other animals maintained as companions to the owner rather than for food animals). The number of full-time equivalent companion animal veterinarians is determined by weighting the number of veterinarians within each of several practice categories by the average pcrtion of their practice which is devoted to companion animal care by the practitioners within that category, as follows:

Number of Companion Animal Veterinarians =

(number of veterinarians in small animal practice, exclusively)

+ (number of veterinarians in equine practice, exclusively)

+ .75 x (mixed practice veterinarians with greater than 50 percent of practice in small animal care)

+.5 x (mixed practice veterinarians with approximately 50 percent of practice in small animal care)

+ .25 × (mixed practice veterinarians with less than 50 percent of practice in small animal care)

5. Size of Shortage Computation. The size of shortage will be computed as follows:

Food

animal

(a) veterinarian shortage (VLU/10,000)—(number of food animal veterinarians).

(b) Companion animal veterinarian shortage (resident civilian pop./30,000)— (number of companion animal veterinarians).

6. Contiguous Area Considerations. Veterinary manpower in areas contiguous to an area being considered for designation will be considered excessively distant from the population of the area or overutilized if one of the following conditions prevails in each contiguous area:

(a) Veterinary manpower in the contiguous area are more than 60 minutes travel time from the center of the area being considered for designation (measured in accordance with paragraph C.1(b) of this part).

(b) In the case of food animal veterinary manpower, the VLU-to-food animal veterinarian ratio in the contiguous area is in excess of 5,000:1.

(c) In the case of companion animal veterinary manpower, the population-to-companion animal veterinarian ratio in the contiguous area is in excess of 15,000:1.

C. Determination of Degree of Shortage

The degree of shortage of a given geographic area, designated as having a shortage of veterinary manpower, will be determined using the following procedure:

1. Grouping of Areas. Designated areas will first be grouped as follows: Group 1Areas with a food animal veterinarian shortage and no veterinarians. Group 2-Areas (not included above), with a food animal veterinarian shortage and no food animal veterinarians. Group 3-All other food animal veterinarian shortage areas. Group 4-All companion animal shortage areas (not included above), having no veterinarians. Group 5-All other companion animal shortage areas.

All group 1 areas are assumed to have greater shortage than all group 2 areas, all group 2 areas are assumed to have a greater shortage than all group 3 areas, etc.

2. Relative Shortage within a Group. In comparing any two areas within group 1, or any two areas within group 2, the area with the larger number of VLU's will be assumed to have the greater shortage. In comparing any two areas within group 3, the area with the larger ratio of VLU's to food animal veterinarians will be assumed to have the greater shortage. In comparing any two areas within group 4, the area with the larger human population will be assumed to have the greater shortage. In comparing any two areas with group 5, the area with the higher ratio of population to companion animal veterinarians will be assumed to have the greater shortage.

PART 21-COMMISSIONED OFFICERS

Subpart A-Definitions

Sec.

21.1 Meaning of terms.

Subpart B-Titles

21.11 Officers other than medical officers. 21.12 Designation of specialties.

21.13 Military titles.

Subpart C-Appointment

PROVISIONS APPLICABLE BOTH TO REGULAR AND RESERVE CORPS

21.21 Meaning of terms.

21.22 Submission of application and evi

dence of qualifications.

21.23 False statements as disqualification. 21.24 Physical examinations.

21.25 Eligibility; junior assistant grade. 21.26 Eligibility; assistant grade. 21.27 Eligibility; senior assistant grade. 21.28 Age requirements, Regular Corps, senior assistant grade and below. 21.29 Eligibility; grades above senior assistant grade.

21.30 Determination of creditable years of educational and professional training and experience.

21.31 Eligibility; all grades; academic and professional education and professional training and experience.

21.32 Boards; appointment of; powers and duties.

21.90 Prolonged or frequent absence due to sickness or disability; review of status. 21.91 Reporting of whereabouts during annual, sick, or station leave.

LEAVE WITHOUT PAY WHILE ON DETAIL 21.95 Leave without pay while on detail. Subpart G-Promotion

DEFINITIONS

21.101 Meaning of terms.

PROVISIONS APPLICABLE ONLY TO REGULAR CORPS

21.110 Division of Regular Corps into professional categories.

21.111 Prescription of numbers in grade. 21.112 Establishment of seniority lists. 21.113 Seniority in grade, junior assistant grade.

21.114 Officers of the Regular Corps entitled to the same seniority in grade. 21.115 Restricted grades.

21.116 Promotion to assistant grade.