Training Physicians for Public Health Careers (2007) / Chapter Skim
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3 Physician Training
3 Physician Training
Pages 49-78
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From page 49... ...
Some enter public health through primary specialty training early in their careers or through joint programs sponsored by medical schools and schools or programs in public health. Historically, however, many physicians practicing public health have come to the field from clinical backgrounds, particularly primary care and infectious diseases.
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From page 50... ...
degree, participation in certificate programs and public health training networks, and
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From page 51... ...
At that time neither distinct public health education programs nor any established career patterns for individuals to become public health physicians were in existence. Public health officers were physicians with their own private practices who responded to requests for assistance with epidemic diseases and other crises (Fee, 2003)
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. Preventive Medicine Residencies Formal training in a preventive medicine residency is an important route for physicians seeking training and competence in public health.
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The Preventive Medicine Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) oversees the accreditation of residency programs.
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Preventive medicine residencies offer established 2- to 3-year programs that can lead to board eligibility through a process analogous to the more clinically oriented residency programs. Preventive medicine residencies by their nature usually offer structured short- and long-term guidance and mentorship on the acquisition of public health practice skills in the chosen target areas, as well as career development and job placement opportunities.
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Army tend to be placed in charge of the public health departments responsible for the local, regional, and national health services in the military. Public health physicians are also assigned to political positions, operational units, and academic and research positions.
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From page 56... ...
These residents are usually board certified in a clinical subspecialty before they enter the general preventive medicine residency. Much of the public health training in the Air Force is nonpreventive medicine residency training and focuses on short-course instruction that is much more clinically focused (Mott, 2006)
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From page 57... ...
has been a major source of training funds for schools and programs of public health, however funding for public health workforce development has steadily declined. By 2002 health professions program funding levels had been reduced to $10,473,000.
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Furthermore, the report identified crucial gaps in the public health education curriculum, including informatics, communications, cultural competency, genomics, community-based research, global health, policy and law, and ethics. Currently, discussions are ongoing about how the recommended changes should be incorporated into the curriculum and the approaches that schools of public health use to educate public health professionals, including physicians.
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Public Health Training Networks In 1993, the CDC, along with state, local, and academic partners, launched the Public Health Training Network (PHTN) to enhance the educational delivery system for the public health workforce.
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. More than 20 competency-based state and regional public health leadership institutes offer a 1- or 2-year educational experience for individuals who are career public health professionals or who work with public health agencies (Rowitz, 2001)
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Since 2001 this distribution has shifted toward state and local health departments.3 Although the number of EIS officers has increased, the percentage of physicians dropped below 50 percent for the first time in 2006 (Table 3.3)
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. SuPPORTINg MECHANISMS Many public health professionals receive training in public health through what are termed "alternative pathways," that is, through short courses and continuing education programs, conferences, workshops, and
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Distance Learning Those in the public health workforce must be prepared to respond to the ever-changing health needs of individuals and entire communities. Public health professionals at all levels need access to viable continuing education options to effectively employ best practices.
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All CME activities receive either a Category 1 or a Category 2 designation. Category 1, the most common type of CME activity required by states, is awarded to providers who offer continuing education alternatives that have received approval from a CME accreditation body, such as the Accreditation Council for Continuing Medical Education.
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Public health physicians could then use these CME credits to comply with education requirements for state licensure or organizational requirements. Academic Health Departments Partnerships between academic institutions and state and local health departments seek to enhance the capacity of the public health workforce and effectively target academic resources to the needs of local communities.
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. Washington State Public Health Officer Orientation: An Example To strengthen local public health leadership and management, the Washington State Department of Health and the Washington State Association of Local Public Health Officials developed an orientation program to help prepare local health officers (LHOs)
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None of the credentialing programs, however, appears to have any component specific to the role or functions of public health physicians. In 2005, the National Board of Public Health Examiners (NBPHE)
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recommended that medical schools provide all medical students with basic public health training (i.e., training in the population-based prevention approaches to health) , that academic health centers undertake serious efforts to provide joint classes and clinical training in public health and medicine, and that a significant proportion of medical school graduates be fully trained in the ecological approach to health.
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From page 69... ...
. Furthermore, the committee recommends that • three additional areas be included in this basic education: lead ership, clinical and community preventive services, and public health emergency preparedness; • organizational partners (including, but not limited to, the Association of American Medical Colleges, the Association for Prevention, Teaching, and Research, the American College of Preventive Medicine, the American Association of Colleges of Osteopathic Medicine, the Association of Schools of Pub lic Health, the Council of Accredited MPH Programs, and the American Association of Public Health Physicians)
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From page 70... ...
Physicians Engaged in Some Public Health Activities Although an understanding of basic public health concepts is important for all physicians, a smaller number of physicians require a greater amount of knowledge of public health concepts and skills because a specific portion of their practice, practice setting, or practice role involves public health. Many physicians have taken on specific public healthrelated roles and functions in their practices and would benefit from focused population health training.
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From page 71... ...
To ensure that these expectations are met, these career public health physicians require specific, enhanced public health training. Therefore, the committee recommends that • physicians with careers in public health acquire a master of public health degree from schools or programs in public health or through preventive medicine programs; or acquire a com parable degree or experience (e.g., through the federal or state
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It is to be hoped that other measures recommended in this report will help encourage physicians to complete an MPH. The committee believes it is important that, at a minimum, public health physicians understand the basics of each of the recommended content areas and the application of those basics to public health.
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From page 73... ...
As discussed in detail in Chapter 2, the estimated number of physicians currently in governmental public health practice is 10,000, with an estimated need for 20,000 physicians and an annual replacement need of 1,350. The committee focused particular attention on ensuring that sufficient numbers of governmental public health physicians are available and that the number of physicians pursuing careers in public health can supply this number on a routine basis.
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From page 74... ...
Maintaining alternative pathways for education in public health cannot come at the expense of the training and competency of practicing public health physicians. However, it is unrealistic and potentially counterproductive to expect that all physicians, especially those making a midor late-career change, will take the time necessary to complete standard preventive medicine residency training or enroll in a school or program of public health.
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From page 75... ...
2000. Fifteenth report: Financing graduate medical education in a changing health care enironment.
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Paper presented at Second Meeting of the Committee on Training Physicians for Public Health Careers, Washington, DC. NBPHE (National Board of Public Health Examiners)
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From page 77... ...
IOM Committee on Training Physicians for Public Health Careers. Paper presented at Meeting of the Committee on Training Physicians for Public Health Careers, Washington, DC.
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