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J U L Y - A UGU S T 2 0 1 1 / F OR E I GN S E R V I C E J OU R N A L
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2011 AFSA CONSTRUCTIVE DISSENT AWARD WINNERS
Profiles of award winners written by Donna Ayerst
The Christian Herter Award
FOR A SENIOR FOREIGN SERVICE OFFICER
Dr. James W. Bayuk
T
he nomination for this award states: “Dr. Bayuk has led a
‘quiet revolution’ in the State Department’s Office of
Medical Services for many years. His recommendations
have not always been popular ones and his ideas have not
always been adopted, but he always has conducted his dissent
within State Department channels. In an era of tight budgets,
we need more officers like Dr. Bayuk, who take the time and
effort to come up with creative, cost-saving measures to make
our systemmore efficient and responsible to the administration
and the taxpayers.”
Bureaucracies can be averse to change, even when it will
lower costs, increase productivity and provide better service.
But Dr. James W. Bayuk, the Regional Medical Officer in
Pretoria, is not averse to change. In fact, you could say that he
embraces it.
Why would someone who works in a bureaucracy embrace
change? Especially when organizations can fear change and that
fear can lead to unpleasant experiences for employees, such as
less-than-stellar performance evaluations or a steeper climb to
get to the top. This fact doesn’t seem to bother Dr. Bayuk.
Whenever he sees a problem, he instinctively wants to fix it
—making him a conscientious public servant. Luckily for the
American taxpayer, when Dr. Bayuk fixes a problem, it saves
money. His uphill battles haven’t always been successful, but
that doesn’t stop him from trying.
Take, for instance, the mammogram and X-ray unit in the
Department’s Office of Medical Services, where Dr. Bayuk
worked from 2000 to 2004. As more and more private com-
mercial labs opened in Washington, D.C., Dr. Bayuk argued
for the closing of MED’s underutilized and overstaffed unit.
According to his calculations, “The State Department was
spending over $200,000 each year to keep the unit operating,
even though it was performing far fewer mammograms and
X-rays in a day than any commercial lab.”
“The government should not be in the business of providing
lab work and medical screenings, when contracting these ser-
vices out can save the government substantial costs,” he argued.
Dr. Bayuk’s reasoning ran into strong opposition from the
Bureau of Human Resources, the laboratory staff and MED
leadership.
One of Dr. Bayuk’s arguments concerned technology. If you
worry about keeping up with the latest iPod or computer tech-
nology, think about trying to keep up with the latest mammo-
gram or X-ray technology. Commercial labs have state-of-the-
art technology. Pivotal to Dr. Bayuk’s argument was the fact
that Foreign Service employees could go to private labs as close
as three blocks away from State and obtain better services,
which would be covered by the employee’s federal health insur-
ance benefits at less cost to the department.
“When talking about what are government services, you
have to ask what an essential service is. Laboratory services are
not an inherent function of the government,” maintains Dr.
Bayuk. The X-ray unit was finally closed in 2003.
That’s not all. In 2006, Dr. Bayuk received the department’s
Award for Innovative Technology, for making it possible to link
post-specific (not personal) medical information to the
Overseas Briefing Center, making it available to everyone via the
Internet.
Dr. Bayuk also set his sights on closing MED’s blood-draw-
ing lab as far back as 2002. In this case, he cited much larger
cost-savings and quality-improving factors. He maintained that
all MED needed was a phlebotomist to draw blood, transport it
to a commercial lab, which could deliver results electronically
the same day. Yet despite a 2006 Office of the Inspector
General report recommending a review of laboratory services
and outsourcing as a cost-effective alternative and the concur-
rence of the medical director in 2007, the lab remains open.
Currently under his scrutiny: transparent bidding for MED
leadership; State’s medical clearance process; absence of clear
guidance on how medical issues are now going to be managed
overseas; using available technology and systems instead of
spending millions of dollars to develop a bespoke product; and
fitness for duty examinations. Who knows what he will focus
on next?
Dr. Bayuk is just the kind of public servant the Foreign
Service needs.
Dr. James W. Bayuk heads up the medevac center in Pretoria.