What Is a Public Health Doctor?
During a recent clinic session, I was reminded of why public health matters to my individual patients. Pregnant and living in a shelter with her children, my patient struggled to make ends meet with a job as a security guard. Her primary school–age daughter was obese and already had high blood pressure. In the 15 minutes I had scheduled with each of them, how was I going to improve their health? As a primary care doctor, I was there for their current needs. As a public health doctor, I was sure there were more-effective ways to solve their problems.
A public health doctor is able to treat not just the individual patient, but a whole community or population. Public health is defined by the World Health Organization as “all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole.” In addition to providing direct patient care, public health physicians are often program managers and policy advocates, involved in teaching and research related to public health. They may work in public agencies, private industry, nonprofit organizations or academia.
Training Public Health Doctors
In addition to my training in family medicine, I completed a second residency in preventive medicine so I could learn how to address health at the population level. What my pregnant patient most needed, in addition to primary care, was a living wage and affordable housing. Her daughter needed access to affordable, healthy food. As a public health doctor, I have devoted time to advocating for family-friendly policies such as paid sick days. I have helped advocate for, implement and evaluate healthy food policies, such as Green Carts (street vendors selling fresh fruits and vegetables in poor neighborhoods).
I also teach future doctors to engage in this work, whether I am serving as the public health team captain for Einstein’s longitudinal Population Health and Practice of Medicine (PHPM) curriculum, the public health track director for SOAR (Student Opportunities for Academic Research, Einstein’s scholarly concentration program) or the director of a new Montefiore Health System residency in preventive medicine. Only some doctors will devote the bulk of their time to public health. In the same way that every medical student needs to understand the basics of obstetrics or surgery, all medical students, I believe, need to carry with them the essentials of public health practice.
Shortage of Public Health Doctors
The 2003 report from the Institute of Medicine (IOM) recommended that “all medical students receive basic public health training,” with academic health centers providing “classes and clinical training in public health and medicine” and joint “infrastructure to support research collaborations linking public health and medicine in the prevention and care of chronic diseases.” The IOM’s 2007 follow-up and the New York State Public Health Workforce Task Force highlighted the need to double the number of public health physicians in the workforce. Basic public health functions, including controlling outbreaks and promoting healthy behaviors, are impossible if these jobs remain unfilled.
Public Health in the Einstein Curriculum
As Dr. Pablo Joo, assistant dean for medical education at Einstein, outlined in a recent blog post, the PHPM curriculum at Einstein provides a home for important topics that have long been neglected in medical student education. These include public health.
At Einstein, Dr. Jane Bedell, the New York City Department of Health and Mental Hygiene’s assistant commissioner for the Bronx District Public Health Office (and an alumna of an Einstein-affiliated residency program), gives the highly acclaimed and long-standing introductory lecture on public health. Students are also afforded a solid foundation in the basics of epidemiology over the first two years.
As part of PHPM, we recently strengthened an introductory small group on public health, focusing on case studies of influenza vaccination, as a bridge between the clinical and public health worlds. Facilitators included public health doctors from across Einstein’s affiliates. Working with the psychiatry clerkship, and leveraging Montefiore leadership’s depth in public policy, we are introducing a session on health policy with a frame of access to mental health services.
As we move forward with curriculum enhancement at Einstein and a closer relationship with Montefiore, we are exploring additional opportunities to bridge clinical and public health education, to train tomorrow’s doctors in the skills that our communities need to improve health across populations as well as one patient at a time.