Incoming M1 interested in public health and policy - advice?

[redmen12]

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[passivelynonaggressive]

I would also be interested in such information.

 

[thecook]

Hi all,

I'm an incoming M1 and (broadly) interested in public health and policy. There is quite a bit of advice for people interested in sub-specialties on this forum (for example, doing research and making connections within a particular department), but I wasn't able to find anything similar for people interested in careers in public health.

I am wondering if anyone has general advice about how I can make the most of medical school. For example, are away rotations useful, or are they essentially mini-vacations? Is spending the summer doing research valuable, or would that time be better spent interning at a public health department? Obviously, the number one priority is doing well in school, but any other advice is greatly appreciated.

Thanks!

You could get an MPH. It's not a hard degree to get, and it will give you the specific training in public health. Many MPH programs have health policy tracks. It's not something you would have to do during medical school; it can easily be done after although I think there are some schools that will allow you to take time off to pursue the MPH. Of course, you don't have to have an MPH to work in public health or health policy.

 

[IslandStyle808]

OP if you are interesting in getting an MPH, I'd suggest you looking into a preventative care residency. You could do an internship first and then the residency (3 years total, internship year needs to be done first and the preventative care residency is 2 years). Or you can do the residency after another one (if you did internal medicine then apply to a preventative care residency it would be 5 years total). You wouldn't be paying for the MPH and will be paid the usually resident salary I believe. There is someone on this forum who did their residency in preventative care, will probably leave it to them to give more of the details.

 

[.hematoma.]

Hey! I'm interested in public health, and I've found that the easiest way to go about getting involved is creating your own opportunities... I'm specifically interested in global health, so I developed a research project and am traveling abroad over the summer to collect data. You can also come up with a project you want to do locally and find a doc who is willing to be a PI on your study. You can also start an interest group on your campus.

 

[AnnaSunH]

I am doing a dual MD/MPH program


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[redmen12]

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[repititionition]

find faculty working on things you're interested in (this is the answer to most extracurriculars in med school)

 

[avgn]

I've spent the past 3 years working professionally in the areas related to health policy and a little bit of public health, so I'll have a go. Great to see people who are interested! It's an absolute crime that so few MDs are looking to get involved in these activities because this stuff will impact our future practices way more than some random protein pathway that is found to maybe have some statistically insignificant effect on how it interacts with beta blockers in AMI patients with CHF...*yawn*

The easiest way to start getting involved in school is through research. After all, that is what academia does and is what they teach best. Start by reading the topical sections of interest in NEJM/JAMA, especially the Perspective/Viewpoint pieces that often talk about issues. Get a feel for what kinds of issues in PH/policy interest you, then see if anybody does research on those at your schools. Projects related to utilization, cost, quality, access, prevention of HIV/TB/diabetes, insurance coverage, medical privacy, ACA implementation, etc. etc. will get you to start reading literature and think about these issues at the 50,000 feet macro level. The key term here is "health services research," which is the heavy statistical approach to cost/utilization/access, but these issues and others can be examined in a non-HSR fashion. There'll be plenty of people working on the public health issues at many med schools, I'm sure, esp if there's an MPH program. Health policy (which is much broader in scope beyond health promotion and prevention) is a little harder to find. Look at affiliated law schools, poli sci/econ depts, business schools. These issues are very interdisciplinary so expect to find and hunt for interdisciplinary academics for related work.

Yet these fields are about doing something in the world, though many academics are strictly academic as well and call themselves experts. If that's the angle you wanna pursue, do it. But to me, an academic is not the primary product to be churned out in either PH or health policy. Research is the best way to get introduced to the field, but definitely should not be the extent of your involvement. How else to get involved, then? The answer is in work experience, which I think is where many med students lose interest due to time and academic concerns.

Check out the local public health dept, see if they need any help on an informal internship basis throughout the year. Many of these depts are underfunded and would love an extra hand on projects, esp a competent, smart, sharp med student. City/county would be most accessible, state can also work if telework is possible or if state capital is nearby. Is there an AMSA chapter? If so, do they have a legislative group that advocates at the state level for new bills in the legislature? If not, look into starting one or just start tracking bills in your state and navigating the legislative process. Med students can easily write testimony or speak with legislators about bills that are stuck in committee or up for a general vote. The smaller the state, the easier it is to get involved at this level (generally). Along these lines, find the state senate/house committee that does health care bills and find work with those legislators. Beyond the legislature, try the executive agencies (Dept of ___), again at the city or state level. See if there's a patient advocate office in the city/state, they do very important and meaningful work on behalf of patients. Many legal assistance agencies (i.e., places that offer legal representation for the poor) work on health care advocacy and you could easily get involved if they allow it. Look for nonprofits in the surrounding area that focus on health-related issues and reach out!

The reason most of you are "interested" in PH/health policy but have no idea how to get started is b/c you have no idea what people do in these fields. The point here about the work experience is for you to find out! If something during the semester doesn't work or you don't have time to devote to it, take an internship during the summer after MS1. You might think it's weird to do that in med school, but w/o work experience you can't say you've really been involved in public health or health policy. These are practical fields, not academic ones.

It's sad that there aren't many schools that provide a structure for med students to get real world experience in these fields, so a lot of it will have to be self-motivated. Like I said, a good starting point is the research to get in the thick of the issues first. The professors may also have connections or know who in the community is easy to work and get involved with. If your university has an MPH program, there's almost definitely a "practicum" the MPH folks have to take. Find out who leads the program and ask them for help for a professional placement. I've found the most success by doing it all myself and being proactive, however. I imagine as med students we can only be more attractive to people as free labor! Again, research to start learning the issues, work experience to really get involved! If you're so inclined, there are also a couple books you can read for fun this summer to get a head start on the issues.

Hope that's helpful and I welcome questions.

 

[avgn]

Ah I see that @redmen12 @Lbjisyuki are gonna be around Chicago! It should be soooooooooooper easy to get involved with organizations in the city. Chicago has arguably the most active AIDS advocacy network in the country, and a big city always has nonprofits and gov't entities who might look favorably upon a medical student offering their time on some projects on a part-time basis. Just gotta reach out and see the options

 

[Chromium Surfer]

I've spent the past 3 years working professionally in the areas related to health policy and a little bit of public health, so I'll have a go. Great to see people who are interested! It's an absolute crime that so few MDs are looking to get involved in these activities because this stuff will impact our future practices way more than some random protein pathway that is found to maybe have some statistically insignificant effect on how it interacts with beta blockers in AMI patients with CHF...*yawn*

The easiest way to start getting involved in school is through research. After all, that is what academia does and is what they teach best. Start by reading the topical sections of interest in NEJM/JAMA, especially the Perspective/Viewpoint pieces that often talk about issues. Get a feel for what kinds of issues in PH/policy interest you, then see if anybody does research on those at your schools. Projects related to utilization, cost, quality, access, prevention of HIV/TB/diabetes, insurance coverage, medical privacy, ACA implementation, etc. etc. will get you to start reading literature and think about these issues at the 50,000 feet macro level. The key term here is "health services research," which is the heavy statistical approach to cost/utilization/access, but these issues and others can be examined in a non-HSR fashion. There'll be plenty of people working on the public health issues at many med schools, I'm sure, esp if there's an MPH program. Health policy (which is much broader in scope beyond health promotion and prevention) is a little harder to find. Look at affiliated law schools, poli sci/econ depts, business schools. These issues are very interdisciplinary so expect to find and hunt for interdisciplinary academics for related work.

Yet these fields are about doing something in the world, though many academics are strictly academic as well and call themselves experts. If that's the angle you wanna pursue, do it. But to me, an academic is not the primary product to be churned out in either PH or health policy. Research is the best way to get introduced to the field, but definitely should not be the extent of your involvement. How else to get involved, then? The answer is in work experience, which I think is where many med students lose interest due to time and academic concerns.

Check out the local public health dept, see if they need any help on an informal internship basis throughout the year. Many of these depts are underfunded and would love an extra hand on projects, esp a competent, smart, sharp med student. City/county would be most accessible, state can also work if telework is possible or if state capital is nearby. Is there an AMSA chapter? If so, do they have a legislative group that advocates at the state level for new bills in the legislature? If not, look into starting one or just start tracking bills in your state and navigating the legislative process. Med students can easily write testimony or speak with legislators about bills that are stuck in committee or up for a general vote. The smaller the state, the easier it is to get involved at this level (generally). Along these lines, find the state senate/house committee that does health care bills and find work with those legislators. Beyond the legislature, try the executive agencies (Dept of ___), again at the city or state level. See if there's a patient advocate office in the city/state, they do very important and meaningful work on behalf of patients. Many legal assistance agencies (i.e., places that offer legal representation for the poor) work on health care advocacy and you could easily get involved if they allow it. Look for nonprofits in the surrounding area that focus on health-related issues and reach out!

The reason most of you are "interested" in PH/health policy but have no idea how to get started is b/c you have no idea what people do in these fields. The point here about the work experience is for you to find out! If something during the semester doesn't work or you don't have time to devote to it, take an internship during the summer after MS1. You might think it's weird to do that in med school, but w/o work experience you can't say you've really been involved in public health or health policy. These are practical fields, not academic ones.

It's sad that there aren't many schools that provide a structure for med students to get real world experience in these fields, so a lot of it will have to be self-motivated. Like I said, a good starting point is the research to get in the thick of the issues first. The professors may also have connections or know who in the community is easy to work and get involved with. If your university has an MPH program, there's almost definitely a "practicum" the MPH folks have to take. Find out who leads the program and ask them for help for a professional placement. I've found the most success by doing it all myself and being proactive, however. I imagine as med students we can only be more attractive to people as free labor! Again, research to start learning the issues, work experience to really get involved! If you're so inclined, there are also a couple books you can read for fun this summer to get a head start on the issues.

Hope that's helpful and I welcome questions.

Would you mind sharing what these books are?

 

[avgn]

Would you mind sharing what these books are?

I'm going to restrict recommendations here to ones that examine the substantive nature of health policy/public health. There are plenty of journalistic accounts of these issues but they are insufficient for the goals of becoming acquainted with the material.

The primer to end all primers is Bodenheimer's Understanding Health Policy, Sixth Edition
It covers almost every single possible topic in the field and explains them well. Many MPH curricula use it as a textbook but it's just didactic enough not to be fully dry and boring. Flip to a section you're interested in or just start from the beginning and prepared to be wowed. It's a whole new world.

For a preachy coverage of issues related to the ACA, see Zeke Emanuel's Reinventing American Health Care
Emanuel is an academic who worked in the White House on the ACA and very opinionated, so it's preachy and lopsided but good coverage on the law and related issues. This one is a little more wonky, more data-driven, expected from an academic.

For a history lesson on health care reform in America, read Paul Starr's Remedy and Reaction
If you're not interested in history, skip this at your own peril. This book is historical and political analysis at its most readable and won't put you to sleep if you're interested. It offers good coverage of issues but not as comprehensive since it only deals with examples of "reform" in history.

For coverage on Medicare/Medicaid specifically, the new Medicare & Medicaid at 50 is promising: Medicare and Medicaid at 50
Probably the most academic out of all of these, since it's written by academics on the history, econ, political science, social impact of the two programs. A ton of research in policy focuses on MC/MCD because of their public gov't nature, so it's good background to have but this book is not a sit down and read through it kind. It's a mixture of essays best digested over a period of time.

Unfortunately, for public health specifically, there is no grand wrap-em-up primer like Bodenheimer that exists. Public health in general has always taken a backseat organized medicine because, well, it's a historically underfunded and unorganized field compared to medicine (not an accident by the way, guess who's at fault heh heh). There are excellent books focusing on stuff like social determinants of health, development of vaccines, HIV/AIDS stuff, etc., but they're not worth the effort if you don't know what you're interested in yet.

The best possibility for hardcore PH would be Greg Rosen's classic A History of Public Health
It's an internationally focused definitive history of public health and gives a great overview of many fundamental concepts. But it's focused on infectious disease since that's what people grappled with the most and struggled with. You might think it's outdated since it was written in 1958, but it really is the most complete coverage available out there. Dude goes all the way back to like ancient Greece for his stories...amazing archival research. New version apparently has an updated bibliography of important PH works at the end, so maybe check that out.

I do know Schneider's Intro to PH is good for comprehensive coverage: Introduction To Public Health
But like it's an actual chapter by chapter didactic textbook so let's be real, nobody's gonna read it unless assigned for a class. If you can sit down and plough through it, all the credit to you...

That enuff for ya?

 

[Chromium Surfer]

I'm going to restrict recommendations here to ones that examine the substantive nature of health policy/public health. There are plenty of journalistic accounts of these issues but they are insufficient for the goals of becoming acquainted with the material.

The primer to end all primers is Bodenheimer's Understanding Health Policy, Sixth Edition
It covers almost every single possible topic in the field and explains them well. Many MPH curricula use it as a textbook but it's just didactic enough not to be fully dry and boring. Flip to a section you're interested in or just start from the beginning and prepared to be wowed. It's a whole new world.

For a preachy coverage of issues related to the ACA, see Zeke Emanuel's Reinventing American Health Care
Emanuel is an academic who worked in the White House on the ACA and very opinionated, so it's preachy and lopsided but good coverage on the law and related issues. This one is a little more wonky, more data-driven, expected from an academic.

For a history lesson on health care reform in America, read Paul Starr's Remedy and Reaction
If you're not interested in history, skip this at your own peril. This book is historical and political analysis at its most readable and won't put you to sleep if you're interested. It offers good coverage of issues but not as comprehensive since it only deals with examples of "reform" in history.

For coverage on Medicare/Medicaid specifically, the new Medicare & Medicaid at 50 is promising: Medicare and Medicaid at 50
Probably the most academic out of all of these, since it's written by academics on the history, econ, political science, social impact of the two programs. A ton of research in policy focuses on MC/MCD because of their public gov't nature, so it's good background to have but this book is not a sit down and read through it kind. It's a mixture of essays best digested over a period of time.

Unfortunately, for public health specifically, there is no grand wrap-em-up primer like Bodenheimer that exists. Public health in general has always taken a backseat organized medicine because, well, it's a historically underfunded and unorganized field compared to medicine (not an accident by the way, guess who's at fault heh heh). There are excellent books focusing on stuff like social determinants of health, development of vaccines, HIV/AIDS stuff, etc., but they're not worth the effort if you don't know what you're interested in yet.

The best possibility for hardcore PH would be Greg Rosen's classic A History of Public Health
It's an internationally focused definitive history of public health and gives a great overview of many fundamental concepts. But it's focused on infectious disease since that's what people grappled with the most and struggled with. You might think it's outdated since it was written in 1958, but it really is the most complete coverage available out there. Dude goes all the way back to like ancient Greece for his stories...amazing archival research. New version apparently has an updated bibliography of important PH works at the end, so maybe check that out.

I do know Schneider's Intro to PH is good for comprehensive coverage: Introduction To Public Health
But like it's an actual chapter by chapter didactic textbook so let's be real, nobody's gonna read it unless assigned for a class. If you can sit down and plough through it, all the credit to you...

That enuff for ya?

Thanks so much
I'm definitely going to read those foundational texts. I'm fortunate enough to to be doing. CDC sponsored internship in public health this summer so I'm super excited to learn all about this stuff!

Right now I am very interested in the social determinants of health as well as the cultural aspects of healthcare. If you have any book reccommendations about those topics, it would be greatly appreciated!

 

[avgn]

Right now I am very interested in the social determinants of health as well as the cultural aspects of healthcare. If you have any book reccommendations about those topics, it would be greatly appreciated!

For SDOH you're better off reading what's relevant to you as it comes up instead of looking at books...they tend to be very academic, focused, and not meant for someone to read it straight through. Think very data-oriented text, maybe only 3-4 chapters of conclusions/commentary that are actually readable for an undergrad.

Best I can think of is Marmot's The Health Gap: The Challenge of an Unequal World
It just came out last year and caused a buzz in the academic community for a little bit but fizzed out since it doesn't offer anything new, just a summary. I haven't read it so I don't know as much about it as the previous recommendations, but it's supposed to be for general readers.

If you're going to a CDC gig, though, just read Rosen's history of PH for now. CDC is as classic of a public health institution as there is, so the material there would be much more applicable and helpful for the kind of work you'll be exposed to. (And more importantly, get into the minds of the people who you'll be working with since they're likely traditional public health folks.) Then you can get into Mike Marmot's stuff, starting with the book above. Then you can graduate onto Marmot's previous work, The Status Syndrome, but man that is NOT a page turner and by this point it's 10 years old so idk what differences there are since Health Gap.

 

[Chromium Surfer]

For SDOH you're better off reading what's relevant to you as it comes up instead of looking at books...they tend to be very academic, focused, and not meant for someone to read it straight through. Think very data-oriented text, maybe only 3-4 chapters of conclusions/commentary that are actually readable for an undergrad.

Best I can think of is Marmot's The Health Gap: The Challenge of an Unequal World
It just came out last year and caused a buzz in the academic community for a little bit but fizzed out since it doesn't offer anything new, just a summary. I haven't read it so I don't know as much about it as the previous recommendations, but it's supposed to be for general readers.

If you're going to a CDC gig, though, just read Rosen's history of PH for now. CDC is as classic of a public health institution as there is, so the material there would be much more applicable and helpful for the kind of work you'll be exposed to. (And more importantly, get into the minds of the people who you'll be working with since they're likely traditional public health folks.) Then you can get into Mike Marmot's stuff, starting with the book above. Then you can graduate onto Marmot's previous work, The Status Syndrome, but man that is NOT a page turner and by this point it's 10 years old so idk what differences there are since Health Gap.

Awesome, thanks so much for all the tips and insight!

 

[mats7]

You can intern at a think tank or research institute. Someone I know is interning at PCORI. You could join the AMA, AMSA, or other advocacy organizations and learn about public health and policy issues at the local, state, and national level. In the meantime, you can start learning SAS, R, or STATA over the summer. It may help you a lot if you want to do research in the field later. Cheers!

 

[redmen12]

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