MANY Philadelphians don't realize that our public-health centers aren't staffed entirely by civil-service employees. In fact, the city Health Department relies heavily on contracting and outsourcing rather than hiring workers directly.

The problem? The city pays higher salaries plus at least 10 percent more in administrative costs, to the entities employing the workers. Result? - fewer dollars available for patient care.

These outside entities serve as a giant temp agency that costs the city a small fortune.

It eats away at the department budget, and hurts our ability to move forward with a robust workforce and knowledge base. These agents include the Philadelphia Mental Health Care Corp., Philadelphia Health Management Corp., Planned Parenthood, Hahnemann, Drexel, Temple, Mercy and Penn.

Surprisingly, even though the city does not pay health and pension benefits for these contracted workers, it still costs the city more to pay these contracts than it does to hire workers directly and provide health and pension benefits through union contracts. For example, a nurse practitioner from Mercy is paid a salary of $109,200, while a nurse practitioner employed by the city makes $63,926.

Last fall, District Council 47 (DC 47) of the American Federation of State County and Municipal Employees studied the difference between Health Department contract employees and city workers.

While the last administration's lack of transparency made this information hard to obtain, we sampled 136 contract employees at the department and learned that the difference between them and city employees in equivalent positions was more than $5 million and that if these workers were city employees we'd save over $1 million!

The reasoning behind contracting and outsourcing is often attributed to a cumbersome hiring process, a chafe between civil- service rules and grant-funded positions (in that grant positions need to be filled quickly and often need to be temporary) and general difficulties filling professional positions through the civil- service process.

It doesn't have to be this way.

We can provide quality health care with city employees if we improve and streamline the hiring process for open positions. Among the first changes the city should make is to hire more people in our central and health personnel offices.

One reason behind complaints about the time it takes to fill positions at the health centers and the centers' long lines is insufficient staffing due to insufficient staffing in personnel. These unseen but critical positions were lost during the last two administrations. When the hiring process stalls, positions go unfilled. The bottleneck is so significant, the two previous administrations circumvented their own process and often hired through the mayor's office and managing director's office.

This is a costly trick that needs to change. We hope that the mayor's commitment to full staffing at health centers stays at the top of his administration's priority list.

We also need to address how the city fills grant-funded positions at the Health Department. A money-saving measure agreed to in 1996 making new hires for grant positions civil service employees if their grant is extended beyond two years only needs the approval of the Civil Service Commission.

Working in the Philadelphia Public Health System can be a more attractive option for health care professionals. The city should lobby for state legislation that provides loan forgiveness to health-care professionals who work in public health. New York and Massachusetts are ahead of the curve as both states have implemented or expanded loan forgiveness to physicians who work in underserved areas.

We should look toward legislation to include cost effective incentives for health professionals like doctors, pharmacists, podiatrists and physicians assistants.

And salaries must be increased. The health centers, for example, are desperate for pharmacists, but lack of competitive pay hurts. Additionally, the city should ease residency requirements to allow for the hiring of much-needed pharmacists and for other needed health center employees

Finally, let's together create a real management and worker training budget in the City's Deferred Retirement Option Plan (DROP) and let's make the technological upgrades to bring the City into the 21st century. If the City Personnel Departments were more technologically advanced, we would be able to predict - through DROP - when, for example, we were going to lose a critical mass of nurses, or doctors or another discipline in 5 years. Knowing, planning and training for vacancies due to promotions and/or an exodus will keep vital positions staffed and would be more cost efficient in the long run.

We know that Mayor Nutter cares about public health and sound fiscal policy. We want to work with him to look closely at cost savings and improved health-care delivery at our health centers. If we have a fully staffed Personnel Department and hire, nurture and train our own city employees, we will be better able to provide health care to Philadelphians.