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The Commissioned Corps of the U.S. Public Health Service(USPHS) is the second smallest of the seven Uniformed Services of the United States (Army, Navy, Air Force, Marine Corps, USPHS Commissioned Corps, and Commissioned Corps of the National Oceanic and Atmospheric Acministration (NOAA). All seven uniformed services have the same rank/pay structure, hence Dr. Agwunobi is a "four star" admiral, has the same rank and pay as other four-star flag officers (e.g. the Chief of Naval Operations, Chief of Staff of the Army, etc). We don't take a good ole boy/gal without uniformed service experience and make them an instant admiral in the Navy or general in the Army, Marine Corps, or Air Force. They're promoted to those ranks from within! Why isn't the Surgeon General of the USPHS (a vice-admiral) selected from among the serving USPHS officers? The law requires that when a USPHS officer is appointed the Assistant Secretary for Health (ASH), he holds "four-star" rank. Why wasn't Dr. Agwunobi simply appointed as ASH in a civilian (non-uniformed) capacity, instead of being commissioned an "instant admiral?"
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