Best degree for international medicine/global health?

[sarmatrac]

Hey everyone,

So, I just finished my sophomore year of undergrad. I'm a biology and global development major and strongly considering a career in global health. However, I don't know exactly what the best path to a career in this field is--nor am I entirely sure what type of career I would want. I have heard that an MPH is often insufficient to get a decently paying job, and that jobs are much more scarce than they would be if you coupled the MPH with another degree (like an MD or MBA).

I'm strongly considering an MD, possibly an MD/MPH. I have several questions regarding this path, however. First, what kind of experience/education would I need to have, in addition to the MD, in order to get a job with an NGO/nonprofit? I am currently interning with an organization doing public health research in a developing country--would more of this type of experience be relevant? Secondly, how competitive are jobs in this field and what is an average salary? Thirdly, what area of medicine would be most relevant to concentrate in if I was interesting in working in developing areas--but also wanted to keep the possibility of returning and practicing/working in the public health sector in the US? Fourth, how would the residency/fellowship timeline work? Would I be able to start working internationally for an NGO/nonprofit after receiving my MD (or MD/MPH?) Would I not be able to get a job until after 4-5 years of additional, traditional medical training?

I apologize if any of these questions are confusing or ridiculous or contradictory--I'm not entirely sure what I want to do, and because of that, it can be difficult to find information. Any advice or resources are greatly appreciated. Thank you.

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[Solara]

Hey everyone,

So, I just finished my sophomore year of undergrad. I'm a biology and global development major and strongly considering a career in global health. However, I don't know exactly what the best path to a career in this field is--nor am I entirely sure what type of career I would want. I have heard that an MPH is often insufficient to get a decently paying job, and that jobs are much more scarce than they would be if you coupled the MPH with another degree (like an MD or MBA).

I'm strongly considering an MD, possibly an MD/MPH. I have several questions regarding this path, however. First, what kind of experience/education would I need to have, in addition to the MD, in order to get a job with an NGO/nonprofit?
You need a skill set. Need to have knowledge of global health. Perhaps you know statistics and epidemiology. Many people will say an MPH. I would first look carefully at what you would learn from the MPH. The MD by itself opens up a lot of doors. You just need to make sure you keep up with global health matters on the side.
I am currently interning with an organization doing public health research in a developing country--would more of this type of experience be relevant?
Yes. But try different things, do something new every summer and see what you like.
Secondly, how competitive are jobs in this field and what is an average salary?
Depends where you are. UN and WHO jobs can get pretty competitive as you need lots of experience. Public health doesn't pay too well. With NGOs and nonprofits, they don't pay so much [the salary varies]. WHO salary ranges from $40k-$90k. If you graduate med school with $150k in debt and enter a career in public health that doesn't pay well, you might want to think about that more.
Thirdly, what area of medicine would be most relevant to concentrate in if I was interesting in working in developing areas--but also wanted to keep the possibility of returning and practicing/working in the public health sector in the US?
Internal medicine. Lots of MDs working in global health go this route. Fourth, how would the residency/fellowship timeline work? Would I be able to start working internationally for an NGO/nonprofit after receiving my MD (or MD/MPH?) Would I not be able to get a job until after 4-5 years of additional, traditional medical training?
You would want to do the 3 year internal medicine residency after the MD degree. So 4 years MD, 3 years residency, and then you could start working for NGOs/nonprofits. You could potentially elect not to do a residency if you feel you don't need that clinical training, but again, the MD is an expensive degree, and you absolutely cannot neglect this.

I could go into a really long discussion about the benefits of MD vs PhD in global health. The MD is a very powerful degree in global health and opens up more opportunities since you have clinical training that no one else will have. Look at the leadership and directors of WHO and CDC and you'll see a lot of leadership positions filled by doctors. My short answer is it depends on what you want to do, but otherwise the MD is a great degree to have for global health. But since it's such a long commitment, anyone who wants to get an MD to go into global health should make sure the MD is right for them since med school is not easy.

I apologize if any of these questions are confusing or ridiculous or contradictory--I'm not entirely sure what I want to do, and because of that, it can be difficult to find information. Any advice or resources are greatly appreciated. Thank you.

Check within my quotation of your post, and I put my responses in Bold.

 

[sameas]

Global health is grossly underfunded in the US. If you look at the amount of grant and philanthropic dollars dollars given internationally, it's relatively small. I don't have the stats in front of me, but international NGO funding is either a bit larger or a bit smaller than arts funding. And arts funding is pretty low.

If you look at the NIH, the Fogarty International Center (FIC) has a tiny pot of money compared to the NHLBI and NCI. So try to remember that funding is extremely small thus jobs are scarce. However, I suggest you get involved with Fogerty. My impression is that they are a small, but passionate institute at the NIH. Maybe you could get an internship there--probably the best minds in the country are there. I don't know how many there are. The CDC has fellowships and other opportunities for people recently graduated. You are still in school, but you can research it and apply during your senior year. The CDC's global offerings are a bit unclear--I know they do international stuff, but I find their structure a bit opaque plus they experienced budget costs and have trimmed staff.

You can get work at an international NGO (based in US or abroad), but it takes years of persistence. Probably the most direct route is to do global medical or policy research and publish in respected journals. Then, you may be able to get grants from health foundations or work as a consultant for NGOs. For example, the Commonwealth Fund has an international health program. From what I notice, the department is small and they seem to use PhD-level experts. They have someone on staff writing policy and he/she only has a master's degree. But I think there are probably paid consultants that advise.

A lot of nonprofit work is fundraising and administration. You are valued if you can bring resources to the organization; thus, direct service is less highly valued and there is a surplus of that labor anyway. Thus, getting independent funding from grants and fellowships may make you less risky for a nonprofit. Also, if you are able to successfully raise money, you will have value. I got nonprofit medical/health jobs I was willing to fundraise. I do research and write policy statements, but always geared toward getting more money. If you have a knack for fundraising and are entrepreneurial, you could start your own nonprofit or social enterprise. I have a friend who founded an international human rights nonprofit. After leading the nonprofit for 5 years, she was hired at one of the most prestigious international NGOs and left the US for Geneva. She poured her entire life into the work and had to do a ton of fundraising, but she also wrote policy and did training around the world.

As for skills, definitely learn something marketable and it need not be medicine. If you can build databases, apply biostatistics, conduct valid research, then you'll have value. For example, the Gates Foundation has contracted with companies to analyze massive datasets for discovery of promising treatments for TB and other infectious diseases. So, Gates needs biostatisticians and computer programmers more than frontline docs. Also, Gates needs people on the ground in foreign countries to make relationships and deals to build an infrastructure to eradicate infectious diseases.

This is a brain dump of some ideas. I have dozens of others. TL;DR is: getting a job is extremely hard, but can be done with persistence and strategic skill development.

 

[Bolingbroke]

Also, Gates needs people on the ground in foreign countries to make relationships and deals to build an infrastructure to eradicate infectious diseases.

Wanted: Dealmakers, energetic folks who can hit the pavement and make connections for our burgeoning network. An advertisement for a street pharmacist or a global health worker, you decide.

Global health is grossly underfunded in the US. If you look at the amount of grant and philanthropic dollars dollars given internationally, it's relatively small. I don't have the stats in front of me, but international NGO funding is either a bit larger or a bit smaller than arts funding. And arts funding is pretty low.

The US is the #1 donor to global health causes worldwide, in absolute dollars given. The national endowment for the arts gets something like just $158 million a year, global health gets tens of billions, and they want something like $47 billion per year for AIDS and tuberculosis.

If you can build databases, apply biostatistics, conduct valid research, then you'll have value. For example, the Gates Foundation has contracted with companies to analyze massive datasets for discovery of promising treatments for TB and other infectious diseases. So, Gates needs biostatisticians and computer programmers more than frontline docs.

Obviously, you have to do what you love for a real career, and then apply that to global health. It would be crazy to get experience as a database administrator out of the hopes that the Gates foundation will be hiring for that in the future.

Obama wants to shift the responsibility, (read dollars), from the US to the countries we're sending support to, hence there's been a flatlining in funding for global health, though the absolute amount is quite large. Given the US budget, and demographics, probably global health funding will fall in decades to come, but there may be increased emphasis on getting more bang for the buck, and for partnerships with foreign governments.

 

[sameas]

The US is the #1 donor to global health causes worldwide, in absolute dollars given. The national endowment for the arts gets something like just $158 million a year, global health gets tens of billions, and they want something like $47 billion per year for AIDS and tuberculosis.

Thank you for pointing out the vagueness in my original post. I wasn't careful in writing it and neglected to include citations, so I'll correct myself here. I still maintain that international funding is relatively low. The FY14 global health budget is about $9 billion (about half to HIV/AIDS). For a thorough and clear explanation, read this Kaiser Family Foundation article.

As for philanthropic giving, over $300 billion is giving annually individuals, foundations, bequests, etc. Of that, only 2.5% of that or $19 billion goes to international affairs (includes health and non-health). (Source: Giving USA). I still have trouble wrapping my head around the fact that individuals give so much money, but if that weren't the case, the nonprofit sector would not exist.

Having worked in nonprofit for many years, I know how tight the budgets are. There is rarely an influx of new money that can be used to hire someone. Grant and government contract funding is largely flat and people in senior positions aren't leaving their jobs. Typically, people get jobs to replace a person who left or maybe get a temporary position under a grant. Thus, the competition is rough for people without experience. I had suggested the strategy of making your own job by forming a nonprofit or getting a grant as another route to a career.

I can't say that I'm an expert, as I only know a few people with global health careers. I do believe that success is very well possible, with persistence and willingness to apply for jobs widely.

 

[Bolingbroke]

Thank you for pointing out the vagueness in my original post. I wasn't careful in writing it and neglected to include citations, so I'll correct myself here. I still maintain that international funding is relatively low. The FY14 global health budget is about $9 billion (about half to HIV/AIDS). For a thorough and clear explanation, read this Kaiser Family Foundation article.

Federal funding for global health has flatlines since 2010, at around $9 billion, but given that only $1.7 billion were spent in 2001, historically, global health spending is at a high water mark, though if not increased with inflation, this would slowly be whittled away over many decades.

As for philanthropic giving, over $300 billion is giving annually individuals, foundations, bequests, etc. Of that, only 2.5% of that or $19 billion goes to international affairs (includes health and non-health). (Source: Giving USA). I still have trouble wrapping my head around the fact that individuals give so much money, but if that weren't the case, the nonprofit sector would not exist.

People give a lot of money to their place of worship (about a third of charitable giving), it goes to hiring pastors, rabbis, whomever, and for keeping the lights on. Given that religious institutions, such as churches, also donate money for international aid projects, I think that the giving to religious institutions is in good part seed money for international aid. Without religious institutions, people might also be less predisposed to donate to international health causes in the first place.

Donating to religious institutions and local charities, such food pantries, allows the donors to see the effects of their giving in front of them, perhaps why giving to domestic institutions greatly outweighs that given to international projects.

Given that the GDP of the United States is 15.68 trillion, the roughly $200 billion from individuals is about 13%, but there is also a tax break for charitable giving, corporations give about $100 billion a year to charities. There is also about $60 trillion in accumulated wealth in U.S. households, some of that money is dispersed to charities.

I get what you're saying with international funding being low, as I see it, the economic recession lead the U.S. to scale-back funding for global health initiatives, and other countries followed suit, and funding has kinda flatlined. The politicians are talking about smarter, better targeted programs, and there's probably also a bit of donor fatigue in that the scale of some problems seems to have overwhelmed some donor countries. There's also the reality that some politicians are asking that donor countries, which are increasingly supporting a middle class, do more to fund international health initiatives in their own countries, hence shifting the financial burden to these countries.

I kinda think this is short sighted, and that more needs to be spent on international health, especially given the emergence of stuff like drug resistant tuberculosis. Probably in a couple decades, the scale-back will be seen as a big mistake on the part of the U.S., and to a lesser extent on the part of certain other donors.