5
Conclusion
Great strides in reducing mortality and improving the public’s health were made during the 20th century, with much of the progress due to public health efforts such as vaccines, improved sanitation and hygiene, safer workplaces, enhanced food and drug safety, and preventive health services. Effective public health actions rely upon a well-trained public health workforce. Such a workforce is composed of individuals from many disciplines, including physicians, nurses, environmental health specialists, epidemiologists, and health educators, among others. This report has focused on the critical roles that physicians play in maintaining and strengthening the public health system, identifying what these physicians need to know to engage in effective public health actions, exploring the kinds of training programs that can be used to prepare physicians for public health roles, and examining how these training programs can be funded.
The definition of a public health physician and a vision for the public health physician workforce was developed to guide the work of the committee. A public health physician is defined as a physician “whose training, practice and world view are based in large part on a population focus rather than individual practice, that is, on assuring the availability of essential public health services to a population using skills such as leadership, management, and education as well as clinical interventions” (Gebbie and Hwang, 1998). The committee’s vision for the public health physician workforce is threefold. First, the committee envisions a future in which sufficient numbers of well-trained public health physicians are
working with other public health professionals to address population issues such as health promotion and disease prevention, chronic and infectious diseases, safe food and water supplies, sanitation, and environmental exposures. Second, the committee envisions a future in which sufficient numbers of well-trained public health physicians are available to provide the scientific and clinical input along with the leadership and management necessary for linking and coordinating the efforts of the many participants of a strong public health system, as described in The Future of the Public’s Health (IOM, 2003). Third, in the face of public health emergencies, the committee envisions a future in which there will be sufficient numbers of professionals trained in public health, including physicians, to plan for and prevent these emergencies and to respond to them. Such emergencies would include disasters such as hurricanes, bioterrorism, and emerging or reemerging infections such as pandemic influenza or mumps.
This report explores the many pathways by which physicians may enter careers in public health. The committee also identified three levels of physician involvement with public health: all physicians, physicians with limited roles in public health, and physicians with careers in public health. For each of these levels the report describes the knowledge and the skills that these physicians need for effective public health action. The report also describes various approaches to preparing physicians for careers in public health, including preventive medicine programs, schools and programs of public health, the Epidemic Intelligence Service program, certificate programs, distance learning, leadership networks, and continuing education programs.
The public health system envisioned in the 2003 IOM report The Future of the Public’s Health includes governmental public health agencies at the core working with the health care delivery system, public health and health sciences academia, communities, businesses and employers, and the media. According to that report, governmental public health agencies form the backbone of the public health system and the actions that it takes. Without sufficient numbers of well-trained physicians in this backbone, the entire public health system is weakened.
Estimates of the current number of public health physicians range from 1,400 (American Medical Association) to 22,000 (Bureau of Labor Statistics); however, the methods used to derive all estimates have major flaws, including the lack of a consistent definition of a public health physician. Both because of the difficulty of estimating the broader number of public health physicians and because of the importance and centrality of the backbone to ensuring the public’s health, the central focus of this report is physicians in governmental agencies. The committee’s opinion, based on the calculations described in Chapter 2, is that as many as 10,000
physicians are currently employed in positions in governmental agencies, with an estimated need for an additional 10,000 physicians in positions that this committee would define as requiring a properly prepared public health physician.
To meet the need to train these physicians, the committee has proposed a variety of options both for training and for funding of the training, as reliable financial support for training public health physicians is lacking. Yet, funding these training programs will not be enough to ensure an adequate public health physician workforce. In addition, the challenges to attracting physicians to careers in public health must be addressed. Such challenges include a lack of sufficient numbers of available positions, significantly lower salaries for public health physicians than for their counterparts in private practice, and a lack of flexible training options.
The public health system must be prepared to respond, prevent, and detect health threats that range from natural disasters to bioterrorism, emerging infectious diseases, and chronic health threats such as obesity. An effective public health system requires a well-educated public health workforce that includes sufficient numbers of physicians in a variety of positions. It is important to maintain the incentives and ability for physicians to become career public health physicians through a number of different pathways. Although much work remains, the recommendations contained in this report outline the beginning steps that must be taken to ensure that sufficient numbers of well-trained physicians are available to help keep the public healthy.
REFERENCES
Gebbie, K., and I. Hwang. 1998. Preparing currently employed public health professionals for changes in the health system. New York: Columbia University School of Nursing, Center for Health Policy & Health Services Research.
IOM (Institute of Medicine). 2003. The future of the public’s health in the 21st century. Washington, DC: The National Academies Press.
