Training Physicians for Public Health Careers (2007) / Chapter Skim
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2 Physicians in Public Health
2 Physicians in Public Health
Pages 29-48
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From page 29... ...
In any list of the multiple professions needed for the high-quality practice of public health, physicians are included with nurses, dentists, veterinarians, environmental health specialists, laboratorians, epidemiologists, health educators, and others. In the early years of the 20th century, statutes that established public health departments at the state and local levels required that the public health official (the public health officer or health commissioner)
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From page 30... ...
Finally, some physicians have careers in public health; that is, they can be identified as specializing in public health, whether they practice this specialty for their entire career or enter it as a change in specialty at some point in their career. These public health physicians work in a variety of settings, including nongovernmental organizations, managed care organizations, occupational medicine, aerospace medicine, academia, public hospitals, and governmental agencies.
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From page 31... ...
As described above, all physicians are a part of the public health system; for a smaller number of physicians, a portion of their practice involves public health, while career public health physicians practice in a wide range of settings, including governmental public health agencies.
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From page 32... ...
These areas are leadership, public health emergency preparedness, and clinical and community preventive service provision. Each of these areas is described in detail in the following sections.
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From page 33... ...
PHYSICIANS IN PUBLIC HEALTH TAbLE 2.1 Public Health Content Areas for Physician Training Application for Public Health Physicians Area Description Biostatistics Collection, storage, retrieval, Development of commentary to analysis, and interpretation clarify statistical information for of health data; design and clinicians; accurate interpretation analysis of health-related of statistical information in surveys and experiments; publications and reports; and concepts and practice of understanding the strengths and statistical data analysis weakness of studies when their findings are applied to diverse communities; and ability to explain these to professionals, policy makers, and the general public Epidemiology Distributions and Development of clinically determinants of disease, sound case definitions for disabilities, and death in investigations and surveillance; human populations and the teaching and encouraging characteristics and dynamics clinicians to ensure their of health and illness in participation in reporting and human populations investigations; and assessing, describing, and developing interventions for health issues in communities Environmental Environmental factors, Accurate interpretation of health sciences including the biological, environmental influences on physical, and chemical factors health in responding to illnesses that affect the health of a or outbreaks; consultation community with environmental health professionals; assisting with development of programs and policies that prevent or mitigate environmental health hazards; and articulating the human health aspect of environmental issues Providing assurance that health Health services Planning, organization, policy and management do not administration administration, management, misuse medical information evaluation, and policy or neglect important clinical analysis of health programs insights; developing and managing governmental or community programs; and working with governmental, hospital, and other health care systems continued
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From page 34... ...
TRAINING PHYSICIANS FOR PUBLIC HEALTH CAREERS TAbLE 2.1 Continued Application for Public Health Physicians Area Description Integration of health promotion Social and Concepts and methods of and health information in behavioral social and behavioral sciences program planning and delivery sciences relevant to the identification and development of multifaceted and the solution of public approaches to community health health problems issues Policy contribution to the Informatics Systematic application of development of informatics to information, computer ensure utility for the intersection science, and technology of medicine and public health to public health practice, research, and learninga Interpretation of genomic Genomics Application of basic public information relevant to problems health sciences to genomic of public health importance issues and studies and accurate provision of this information to other physicians Communication Skills required to interact Use of best practices in with different groups within communication to act as a the public health system, bridge between public health including policy makers, professionals in general and health care providers, media, physicians from all settings and and lay citizens in communicating information about public health to the public, working with media, presenting information to diverse communities and to policy makers; and addressing professionals Cultural Communicating and adapting Demonstration of the competence public health messages and highest possible level of methods in ways that respect competence in dealing with the values, opinions, beliefs, the multiple cultural groups and practices of people in in the community, effectively various communities identifying and responding to the needs and concerns of diverse populations, and working to address health disparities Community- Research methods that Provide assurance that based emphasize communities as when public health engages participatory research coequals, collective in research, it does so as a research visioning, incorporation of partner with the community; social ecology approaches, sharing this perspective with and using multiple data medical researchers using more collection methods traditional approaches to studies
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From page 35... ...
PHYSICIANS IN PUBLIC HEALTH TAbLE 2.1 Continued Application for Public Health Physicians Area Description Global health Cross-country factors Interpretation of international that foster conditions for information for application poor health and global to domestic public health environmental changes problems, collaboration with that lead to such things as physicians internationally to depletion of fresh water foster improved health, working supplies, loss of arable lands, with immigrant and refugee and reemergence of infectious populations, and preparing diseases health professionals to work in international settings Policy and law Application of political Consultation to ensure that science, economics, and proposals to change policy or administration to promote law are consistent with current sound health policy, public medical and public health health law, and the uses of science and communication law to promote the public's about public health policy and health law to medical colleagues Ethics Ethical basis for practice Modeling the highest ethical of public health, including standard of behavior for all the belief that people are colleagues in public health and interdependent on each other clinical medicine, contributing and the environment; the to the ethical interpretation priority of addressing the root of proposals or events, and causes of health and illness; balancing the needs and and a commitment to using resources for individuals and the the best available information community and among different in determining actions populations aDefinition taken from Yasnoff, W
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From page 36... ...
He or she understands that what happens at a clinical level can provide much useful information about disease prevention at the community level and the importance of these issues in promoting the core public health functions of assessment, policy development, and health assurance (IOM, 1988)
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From page 37... ...
For example, the responsibility for the regulation of state and local emergency medical services has been located in public health agencies and has always included medical oversight. Most governmental emergency preparedness and disaster plans give the responsibility for planning for and response to the health component of the plan to state and local public health entities.
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From page 38... ...
Public health physicians are routinely required to provide advice to the practicing physician in a number of clinical domains. Among the most common are immunizations and vaccines, the diagnosis and treatment of diseases of public health importance, clinical preventive guidelines, community preventive services relevant to the clinical domain, and guidelines and precautions for international travel.
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From page 39... ...
, it is important not only to look at training future public health physicians but also to ensure that those currently engaged in public health careers are adequately trained. NuMbER OF PubLIC HEALTH PHySICIANS Given the lack of any single database that identifies public health physicians and the lack of any common definition of the term "public health physician" used across more limited data sets, it is difficult to determine accurately the number of physicians engaged in public health careers today.
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From page 40... ...
Both because of the importance and centrality of governmental public health in assuring the health of the public, and because available data focus on physicians in governmental agencies, estimates of the current number of public health physicians focuses on those in governmental agencies. However, it is also difficult to estimate the numbers of physicians currently engaged in governmental public health careers, because information about physicians specializing in public health is incomplete.
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From page 41... ...
The BLS data include all physicians working on governmental payrolls, including those in public hospitals and community clinics, employee health clinics, and clinical research settings, as well as public health agencies. For this reason, it cannot be considered an accurate source of information about the numbers of physicians working in official public health agencies or other governmental agencies with public health functions, such as environmental, mental health, and agricultural functions.
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From page 42... ...
HOW MANy PubLIC HEALTH PHySICIANS ARE NEEDED? If the estimated number of physicians currently employed in public health was reasonably accurate and reflected fully met need and if these physicians followed a typical work career, it would be relatively simple to estimate the number of replacement physicians who need to be trained for public health careers over the coming decades.
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From page 43... ...
It is likely, however, based on the minimal data available regarding understaffing presented earlier in this report and on the committee's expert opinion, that state public health agencies, except for those serving very small populations, need more physician participation, perhaps as many as 10 more in key leadership positions in the state agency (38 states × 10 physicians = 380) .4 An additional 10 physicians might be needed in specialized programs in health departments (for example, in clinical services programs)
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From page 44... ...
Given the difficulties in accurately estimating the number of public health physicians in practice today, as well as the difficulty of extrapolating that number to the number required to meet future needs, the committee has chosen to use expert opinion, as described above, to arrive at the conclusion that the country needs 20,000 physicians in public health careers, an increase of 10,000 over the current number engaged in public health careers. The number 20,000 provides a more comfortable margin that allows the inclusion of the public health physicians needed by community partner agencies, such as voluntary health associations, infection control physicians employed by hospitals or health care systems, and physicians employed by academic institutions, such as schools of medicine or public health.
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From page 45... ...
Therefore, once the desired number of 20,000 public health physicians in governmental agencies is reached, the system must have the capacity to train at least 1, 350 new physicians each year to replace those leaving public health careers. CONCLuSION AND RECOMMENDATIONS Although this report is focused on education for physician careers in public health, it is important to note that many more physicians than those with public health careers engage in public health activities at some point.
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From page 46... ...
• the information regarding public health physicians obtained in the periodic assessment of the public health workforce be used to project needs for public health physicians and public health physician education programs, and to determine the level of funding necessary to prepare physicians to fulfill those needs. Using the data that are available, in addition to expert opinion, the committee has determined that the current public health physician workforce for governmental public health agencies is probably about 10,000.
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From page 47... ...
Paper presented at Second Meeting of the Committee on Training Physicians for Public Health Careers, Washington, DC. NACCHO (National Association of County and City Health Officials)
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