EM and Public Health?

[blackbird03]

Hi

I was wondering if anyone here is interested in combining public health with EM. I would think working as an EM physician would provide with a special position to affect public health in the community. I am personally interested in access to health (uninsured), prevention, quality assurance. I'm starting my first year of residency next year. Anybody have any experience or comments about post-residency MPH programs? Are there community job positions which allow EM docs to apply their MPH knowlegde or is it only an academic exercise?

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[dlung]

Hi

I was wondering if anyone here is interested in combining public health with EM. I would think working as an EM physician would provide with a special position to affect public health in the community. I am personally interested in access to health (uninsured), prevention, quality assurance. I'm starting my first year of residency next year. Anybody have any experience or comments about post-residency MPH programs? Are there community job positions which allow EM docs to apply their MPH knowlegde or is it only an academic exercise?

Huh. If you're interested in all that, how come you're not in our intern class? Or are you?

The short answer is that there are no community jobs for that interest. Even in academia, a good rule of thumb for any "extra-curricular" career activities, is plan on "buying" your time... whether that is with research, publicity, consulting, etc.

There are a number of post-grad policy opportunities in all that you mentioned at Capitol Hill, NIH, DHHS, CDC, several residency programs across the country, and probably others I don't know of. That's how you'll get hands-on experience and time to focus your interests. Most are excellent by reputation.

 

[iridesingltrack]

Hi I was wondering if anyone here is interested in combining public health with EM. I would think working as an EM physician would provide with a special position to affect public health in the community. I am personally interested in access to health (uninsured), prevention, quality assurance. I'm starting my first year of residency next year. Anybody have any experience or comments about post-residency MPH programs? Are there community job positions which allow EM docs to apply their MPH knowlegde or is it only an academic exercise?

Like you, I am an incoming intern. Before medical school I got an MPH and worked for a few years. I agree that EM is uniquely positioned in regard to its relationship with public health. I see the ED as the place where public health intersects with medicine in the broadest sense. I think every patient offers an opportunity to identify how the existing public health system is not meeting the needs of the patient and possibly the greater community.

I think that any MPH program would meet your post-residency plans. As with choosing your residency, your training goals will likely dictate what program you choose. Some programs, Harvard comes to mind, focus on providing MPHs to practicing physicians. In my MPH class (not Harvard) we had several physicians, some were doing a research fellowship where the MPH was totally funded.

If by community job you mean private practice I'm not sure that you will find what you are looking for; however, I'm sure you could do what you want but it would likely be funded by you. But, if you mean non-academic positions for physicians interested in public health then yes. Physicians work in all levels of governmental public health: County health dept, state health dept and of course, nationally (CDC, NIH etc.) as the previous poster mentioned. If you don't want to commit to full time Public Health you could eventually look into consulting, advising/lobbying your elected officials, or even sitting on local public health boards. I would bet that your residency program will help you greatly as you focus your interests.

Feel free to PM me if I've failed to address your questions or if you have any other questions.

 

[AmoryBlaine]

Like you, I am an incoming intern. Before medical school I got an MPH and worked for a few years. I agree that EM is uniquely positioned in regard to its relationship with public health. I see the ED as the place where public health intersects with medicine in the broadest sense. I think every patient offers an opportunity to identify how the existing public health system is not meeting the needs of the patient and possibly the greater community.
I think that any MPH program would meet your post-residency plans. As with choosing your residency, your training goals will likely dictate what program you choose. Some programs, Harvard comes to mind, focus on providing MPHs to practicing physicians. In my MPH class (not Harvard) we had several physicians, some were doing a research fellowship where the MPH was totally funded.

If by community job you mean private practice I'm not sure that you will find what you are looking for; however, I'm sure you could do what you want but it would likely be funded by you. But, if you mean non-academic positions for physicians interested in public health then yes. Physicians work in all levels of governmental public health: County health dept, state health dept and of course, nationally (CDC, NIH etc.) as the previous poster mentioned. If you don't want to commit to full time Public Health you could eventually look into consulting, advising/lobbying your elected officials, or even sitting on local public health boards. I would bet that your residency program will help you greatly as you focus your interests.

Feel free to PM me if I've failed to address your questions or if you have any other questions.

The ED very well might be the best place to observe public health issues, whether it is the best place to address them is a different question.

My impression on my upcoming residency and career is that your job priority as an emergency physician is to move patients. Sure, when you see that person with untreated DM, chlamydia, whatever you can say "here is a failure of the system as a whole" and then take appropriate steps to correct and (quickly) educate.

What an MPH is going to add to this daily treatment paradigm is unclear to me but my guess is probably very little. If you want to eventually have a more academic, public, or research oriented career then sure, EM has it's place in public health just like Peds, FP, Gyne, etc.

 

[iridesingltrack]

The ED very well might be the best place to observe public health issues, whether it is the best place to address them is a different question.

My impression on my upcoming residency and career is that your job priority as an emergency physician is to move patients. Sure, when you see that person with untreated DM, chlamydia, whatever you can say "here is a failure of the system as a whole" and then take appropriate steps to correct and (quickly) educate.

What an MPH is going to add to this daily treatment paradigm is unclear to me but my guess is probably very little. If you want to eventually have a more academic, public, or research oriented career then sure, EM has it's place in public health just like Peds, FP, Gyne, etc.

Amory,

I don't disagree at all. There are multiple steps to addressing a problem, the first of which is identification of the issue. The ED provides a great opportunity to identify gaps in the public health system or even new and emerging problems (think SARS, West Nile, increasing primary care type complaints, lengthening boarding times, new patterns of drug use/abuse/od etc.) that may represent larger systemic issues. Part of the reason that I believe EM is unique in its relation to public health relative to other fields, which of course have a mighty important place in public health, is the breadth of patient complaints, and that the ED is often a patients point of access to the healthcare system.

As with any physician, your primary responsibility is to the patient in front of you; but, I would argue that we also have a secondary responsibility to the health of the community and one way that we can fulfill that role is to be sensitive to the patterns of patients we are seeing. For example, are we seeing an increase in flu among previously healthy, low risk patients. When we are in the ED, pattern recognition (passive surveillance), complying with reporting of reportable diseases, and patient education are likely the extent of the public health that we can perform.

Is an MPH going to improve my clinical accumen? Probably not. Is an MPH necessary for EM? Absolutely not...in all honesty, an MPH may not be necessary for a physician to have a career in public health. For me, my public health background will be particularly helpful when I walk out of the ED by providing me a systematic framework for thinking about my noncompliant DM patient, my STD patient, or my geriatric fall and how I may help prevent these types of patients from requiring future ED visits. But, you're correct, addressing the problem is done more in public health circles than in the ED, hospital, or the PCPs office.

 

[docB]

I agree with the comment that EM is really more about observing and treating public health issues than the prevention that is the cornerstone of public health.

That said I do think you can find some niches within academia. There were some professors doing public health related research when I was at UC Davis.
Garen Wintemute is very involved in domestic violence and public helath policy.

http://www.ucdmc.ucdavis.edu/emergency/ourteam/faculty/wintemute.html

Steve Weiss (who is now at U of New Mexico) was involved in some studies about having EMS do public health interventions. For example they would respond to calls and when the patient was not critically ill they would assess for fall risk and pass that info to PT/OT workers who would then intervene. I can't recall if he published that or not.

Bob Derlet did lots of work on the long term effects of meth abuse and he was really involved on research about infectious diarrhea.

EM is particularly well suited for the aspects of public health that get into disaster medicine and emergency preparedness.

So it's not like Tox and it's not big at every academic center BUT it is out there and if you have an interest it might make you attractive as a candidate for an academic position.

 

[nymbarra]

Great post and discussion guys.

Hi

I would think working as an EM physician would provide with a special position to affect public health in the community. I am personally interested in access to health (uninsured), prevention, quality assurance.

I agree.

I don't think there is one specialty better suited for public health, because clinical medicine does not = public health. In clinical medicine, you are focused on the individual, not the population.

However, because EM physicians see a rather large proportion of patients with preventable presentations--and belonging to at-risk groups--we have the credibility to address these issues from a population-based, ie public health perspective...should we choose.

Anybody have any experience or comments about post-residency MPH programs?

I would look into preventive health residencies (eg, Johns Hopkins in which EM is represented) or EM fellowships, which pay for the MPH along w/ salary. Most of the IEM and research fellowships will pay for an MPH.

Garen Wintemute is very involved in domestic violence and public helath policy.

Dr. Wintemute is so ! I saw him a few days after his last NEJM article on gun violence and he was just his usual chill joe-farmer self. Excellent teacher, humble, and passionate about violence prevention.

 

[dlung]

You're at Emory? You should be bragging about Kellerman. He spends a lot of time up here nowadays.

 

[AmoryBlaine]

I agree with the comment that EM is really more about observing and treating public health issues than the prevention that is the cornerstone of public health.

That said I do think you can find some niches within academia. There were some professors doing public health related research when I was at UC Davis.
Garen Wintemute is very involved in domestic violence and public helath policy.

http://www.ucdmc.ucdavis.edu/emergency/ourteam/faculty/wintemute.html

Steve Weiss (who is now at U of New Mexico) was involved in some studies about having EMS do public health interventions. For example they would respond to calls and when the patient was not critically ill they would assess for fall risk and pass that info to PT/OT workers who would then intervene. I can't recall if he published that or not.

Bob Derlet did lots of work on the long term effects of meth abuse and he was really involved on research about infectious diarrhea.

EM is particularly well suited for the aspects of public health that get into disaster medicine and emergency preparedness.
So it's not like Tox and it's not big at every academic center BUT it is out there and if you have an interest it might make you attractive as a candidate for an academic position.

This is absolutely true and something I was going to mention in my previous post. If the OP wants to get involved with some serious PH stuff consider looking into disaster medicine.

Not only are emergency physicians the best trained to coordinate such research/prep etc they are the ones screaming to community leaders "we are not ready!"

In other words, much of our work for disaster preparedness (sp?) is still ahead of us. I am publicly critical of some of the "fellowship" training in EM but I think disaster medicine is an area that needs to be built up to the level of Peds/Tox.

 

[southerndoc]

This is absolutely true and something I was going to mention in my previous post. If the OP wants to get involved with some serious PH stuff consider looking into disaster medicine.

Not only are emergency physicians the best trained to coordinate such research/prep etc they are the ones screaming to community leaders "we are not ready!"

In other words, much of our work for disaster preparedness (sp?) is still ahead of us. I am publicly critical of some of the "fellowship" training in EM but I think disaster medicine is an area that needs to be built up to the level of Peds/Tox.

Just be leary of the fellowships that focus on flu pandemic planning. There are some fellowships out there that base their whole fellowship training on such things. You really need a variety of things: relief medicine, event medicine, pandemics, NBC, etc.

Regarding building up disaster medicine to the level of peds/tox, I think we will see an EMS subspecialty certification process by ABEM within the next 5 years. Dr. Strauss, one of the ABEM directors, recently said that EMS will become the next subspecialty certification and gave a similar time frame when he gave a recent grand rounds lecture. I would imagine EMS would be a pre-hospital/disaster medicine certification. NAEMSP is pushing very hard for this, and the IOM recently recommended it.