Training Physicians for Public Health Careers

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Curriculum for Higher Specialist Training in Public Health Medicine

This is a full-time, permanent confirmation path position. Use the expandable menus below right to browse through content. Careers in Public Health Open or Close A career in public health may include influencing public policy, working to address inequalities, improving living conditions and ensuring the good health of the next generation.

Careers | Public Health Ontario

Other Public Health Unit roles These roles may include working in areas such as information and analysis, 'health in all policies' and health promotion. Funding and Planning These roles are based within District Health Boards and are focussed on needs assessment, population health input to DHB plans and processes, prioritisation and allocative decision making. Advisory Public Health Medicine Specialists work in a variety of advisory roles, including providing advice on regulatory and health policies, service development and planning of programmes.

Leadership and Management These are roles within the health sector that focus on population-based services and personal health treatment services. Academic Public Health These research and teaching roles require a high level of academic expertise, and training for them usually includes a doctorate. Research and Teaching: Roles requiring a high level of academic expertise.

Click here for examples of public health medicine roles in NZ. Registering as a Medical Specialist in Australia Information is readily available on the web regarding how to register as a specialist medical practitioner in Australia.

The following websites outline the Australian regulatory body requirements, immigration issues and general information about working as a doctor in Australia: Medical Board of Australia - Types of Medical Registration Working in Australia DoctorConnect - Specialists Public Health Workforce Development Another very helpful resource for finding opportunities to advance your career in public health is the Public Health Workforce Development website.

Practicing clinicians should be able to look to the public health community for relevant guidelines, professional and technical expertise, and reliable knowledge and opinions, often on a case-by-case basis. Public health physicians are routinely required to provide advice to the practicing physician in a number of clinical domains.

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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. In this area, public health physicians require expertise in general vaccinology and vaccine use information, routine childhood and adult immunization schedules, knowledge and assessment of the possible adverse reactions from vaccines, and use of vaccines in special settings, such as a hepatitis A virus outbreak.

Diagnosis and Treatment of Diseases of Public Health Importance The public health system generally sets the recommendations for the appropriate diagnosis and treatment of diseases of public health importance. Traditionally, these have included endemic infectious diseases of public health importance, such as tuberculosis and sexually transmitted diseases, as well as emerging infectious diseases at the time of first recognition e.

In epidemic settings, for example, a cluster of cases of meningococcal meningitis or an outbreak of Escherichia coli OH7 infection, public health physicians will be called on to establish appropriate diagnostic and treatment guidelines. An additional area of public health physician expertise relates to the diagnosis and treatment of conditions not commonly seen by practicing clinicians, for example, suspect botulism, lead poisoning, malaria, or rabies.

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Clinical Preventive Guidelines Screening for a wide range of preventable conditions or conditions that are treatable if they are caught early mammography and breast cancer, for example is a key element of public health that is conducted by the practicing clinician. In addition to the establishment of clinical screening guidelines, clinicians are often asked to provide patient counseling for selected public health concerns e. Community Preventive Services Relevant to the Clinical Domain Community preventive services are services delivered to populations rather than individual patients. Public health physicians should be knowledgeable and capable of providing advice to clinicians and health systems regarding relevant community preventive services, for example, strategies that can be used to improve immunization rates or the rates of diabetes detection in a patient population.

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Guidelines and Precautions for International Travel Public health physicians are responsible for developing appropriate guidelines and precautions for international travel malaria prophylaxis recommendations, for example. Although practicing clinicians specializing in travel medicine are becoming increasingly common, individual clinicians still seek public health physicians when they apply these guidelines to individual patients and groups of travelers.

Knowledge of travel precautions is thus a core expertise required of public health physicians. Because there are indications that the current public health workforce is inadequately trained in many respects see Chapter 1 , 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. As discussed earlier, all physicians contribute to the practice of public health some of the time, and that number is known. Under current circumstances, however, it is impossible to estimate the number of physicians in other than governmental health settings who are true public health physician specialists or who work in positions that should require that level of public health specialization.

The most reliable data are available only for physicians in governmental agencies. 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. A number of different groups have, however, attempted to determine that number. This information was gathered by use of an electronic survey.

It did not ask for any details about the specialty certification of the physicians and asked only for information about full-time equivalents. The survey thus underestimates the actual number of physicians involved in public health, and there is no way to extrapolate such a number from the data from that survey. The resulting information is only about the single, official local public health agency and thus excludes information about the numbers of public health physicians in local mental health or substance abuse agencies.

The report was based on an analysis of existing data sets from state and some local health departments and was supplemented by information from the federal Office of Personnel Management and the U. Department of Defense. At the state level, only one state was able to report on workers throughout the state government. Categorization was by job title, when such information was available.

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These data are drawn from a variety of sources and are not associated with board certification; therefore, there was no way to verify that the category of practice is consistent with the categories used in other systems. The extremely small number of public health and preventive medicine physicians identified from the AMA data compared with the numbers from the two previous reports suggests that these data reflect only those physicians seen as full-time employees in a public health setting and leaves out all or most of those who do not specialize in public health but practice in public health part of the time.

These are data from employer systems used for the identification of the types or categories of worker. 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.

This represents the proportion of physicians who are known to the specialty board most relevant to public health and who can be identified as working in an official health agency. In determining the size of the current public health physician workforce, the committee relied most heavily on Enumeration and BLS data since they are most complete.

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.

Representatives of the U. Department of Defense described to the committee the annual planning that the department performs to determine the number of physicians to be recruited and trained in each specialty area and how it establishes a pipeline of physicians in specialty training programs Mott, Although knowledge of such efforts is useful, the civilian public health world is not such a closed system with known population demands and specified resources.

Two other major caveats to estimating the national need for public health physicians exist: the current number of public health physicians does not reflect the need being met at present, and it is not clear that the career path for physicians in public health is a typical one. Reports from public health agencies regarding the recruitment and retention of staff indicate that there are serious gaps in the current supply of public health physicians.

Furthermore, according to Glass , the numbers of physicians in public health and preventive medicine is decreasing. The committee bases its estimates on the assumption that public health would be served best by physician participation in the public health leadership team, both at the agency level and in major programmatic areas. The committee believes that these figures present conservative estimates, given the continuing increase in public healthrelated knowledge and the demands for a high level of public health practice that cannot be accomplished without an adequate public health physician presence throughout the governmental public health system.

The estimates take no account of the potential need for increases in the numbers of public health physicians in other areas of medical practice. Separation of the numbers of public health physicians at the state and the local levels is not possible at present. Furthermore, the current number of public health physicians working in state and local governmental positions is likely greater than 2, because of the large number 4, of public health physicians reported to work in positions not specified by level of government.

Some of these physicians likely work in official public health agencies.

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Training physicians for public health careers

Population by state. Given that these figures are not exact, the committee has chosen to adopt a range for estimated need of 2, to 3, For local health agencies, it may be that very small health agencies might successfully be served by fewer physicians. The estimated total number of physicians needed for local public health agencies, then, would be 13, Again, because of the lack of specific data, the committee has chosen to express the estimated number of physicians needed in LHDs as a range from 10, to 15, Such numbers would bring the estimated potential total number of public health physicians need for state and local public health agencies to between 12, and 18, By using the same leadership and programmatic criteria outlined above, the federal public health agencies primarily the U.

Department of Health and Human Services and the U. Departments of Agriculture, Labor, and Veterans Affairs could need 4, public health physicians an increase of over the current estimate.

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Looking at all of these estimates, the estimated number of physicians needed in governmental public health agencies ranges from 17, to 23, 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, physicians in public health careers, an increase of 10, over the current number engaged in public health careers.

The number 20, 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.

It is also essential to plan for the replacement of physicians leaving the public health workforce because of retirement or for other reasons. This figure is arrived at by dividing the estimated number of physicians needed 20, by the estimated average length of a career in public health 15 years. Therefore, once the desired number of 20, public health physicians in governmental agencies is reached, the system must have the capacity to train at least 1, 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.

The committee has identified three broad groups of physicians who are considered to practice public health: all physicians, those who practice public health for a limited amount of time or in a limited role, and physicians who choose a career in public health. As can be seen from the preceding discussion in this chapter, estimating the number of physicians currently in public health careers, as well as the number needed for an adequate workforce, is hampered by a lack of data. Although various attempts have been made to collect data on the number of public health physicians practicing in the United States, each is flawed in different ways, which makes it extremely difficult to estimate accurately both the current pool of public health physicians and the desired number.