MPH and EM?

[OB1🤙]

So my school offers an MPH without any extra years of school, and it sounds like a great opportunity. I've always been interested in community health, preventive health, public health education, etc.

BUT, I'm definitely going to be going into EM, and I wonder if I'd be wasting my time by going for the MPH. Will I ever use it in the ED at all? Will I have time to do community stuff outside of work?

Some factors influencing this decision are 1) it's about $12K for the MPH degree on top of my existing $200K+ debt (although there's a possibility I might be able to get a scholarship for it), 2) I'd have to give up this upcoming summer, which would be the last summer I'll ever have, and 3) whether it would help at all with residency apps to have it.

Factors 1 & 3 are pretty superficial and don't really matter too much, and #2 shouldn't either, but if I'm giving up a summer of surfing and seeing friends and family at home in Hawaii vs. sweltering in New Orleans working on a degree I'll never use, well, you see the dilemma. This will probably be the last chance I'll get to be at home for any real amount of time until I'm done with residency 7-8 years(!) from now.

Any thoughts or opinions?

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[sixteenstones]

You can never have too much education. While you may not apply it directly to EM, I am sure it will come in handy when you least expect it. Do it, do it now.

 

[gimmedog]

Public health absolutely and directly relates to EM. I was surprised and alarmed that the two previous posts would disagree. Medicine and public health should really go hand in hand, somewhere medical education dropped the ball.

Don't have time to get into all of it but just think about it-- injuries, violence, infectious disease, poverty, policy, access to primary care, substance use, homelessness, health behaviors....I could go on. This is not to mention the universally applicable skills such as epi, biostats.

There's even a public health interest group in SAEM, and EPs had a hand in composing Healthy People 2010.

 

[DrQuinn]

There was a thread on this earlier, go back a few screens and see if you can find it (or just search for MPH and Emergency Medicine).

Don't do it to pad your CV. 'nuff said.

Q, DO

 

[Sessamoid]

Originally posted by gimmedog
Public health absolutely and directly relates to EM. I was surprised and alarmed that the two previous posts would disagree. Medicine and public health should really go hand in hand, somewhere medical education dropped the ball.

As I stated in a previous thread, if you have a passion for it and actually plan on using it, then go ahead and do the MPH. If you don't plan on using it, don't bother.

Yes, EM and Public Health intersect in many ways, but then again so do a lot of other fields in medicine. An MPH will have absolutely zero effect on the clinical practice of emergency medicine, though you may find ways to augment your career in public health, especially if you plan on an academic career.

I'm sorry to contradict you gimmedog, but emergency medicine is about acute medicine, not preventative medicine. We all do some brief teaching on preventative care, but it's not our primary goal, and it's not what I'm interested in doing. Very different personalities.

 

[Sheerstress]

The ED is a mirror of all the places where the public health system fails - it's the safety net for everyone who has nowhere else to go.

 

[Apollyon]

Originally posted by Sheerstress
The ED is a mirror of all the places where the public health system fails - it's the safety net for everyone who has nowhere else to go.

ER Primary Care in a nutshell.

But that's MORE than enough for me!

 

[OB1🤙]

Thanks for the replies- I would definitely NOT be doing it to pad a CV- I really do have a genuine interest in it, and I'll be doing various public health projcts along the way regardless of whether or not I do the full degree.

Put it this way- I'm really interested in the community health/education side of it. I can see how the lack of public health results in patients in the ED that don't need to be there, but I'm not so sure how it would help once they're already there. So my thought is to use it outside of the ED, at community seminars, etc. Hawaii has a huge crystal meth problem, and that's kinda my tentative focus at this very naive, very early stage in this whole process. I've gotten wildly different answers from people I've talked to here (at Tulane), ranging from "you'd be crazy to do it" to "you'd be crazy not to."

The sweet thing about it is that I'm not charged anything for the classes, just the degree at the end. So I'll definitely start the classes in the spring, and decide from there whether or not I want to stick with it.

Thanks for the input, people, and any more would be much appreciated.

 

[Sheerstress]

Put it this way- I'm really interested in the community health/education side of it. I can see how the lack of public health results in patients in the ED that don't need to be there, but I'm not so sure how it would help once they're already there.

There is the notion that when people come to the ED worried about their health, but don't have any truly life-threatening problems, there may be a "teachable moment."

In other words, the patient may be more open than usual to suggestions about changing bad habits (e.g. wearing their seatbelts, quitting smoking, etc.), if they've had a close call. Or more simply, it may be an opportune time to get the patient a primary care provider to care for their diabetes or hypertension if they don't have one. It's during this time that the health education aspect of the ED can really come into play.

 

[gimmedog]

Originally posted by Sessamoid

Yes, EM and Public Health intersect in many ways, but then again so do a lot of other fields in medicine. An MPH will have absolutely zero effect on the clinical practice of emergency medicine, though you may find ways to augment your career in public health, especially if you plan on an academic career.

I'm sorry to contradict you gimmedog, but emergency medicine is about acute medicine, not preventative medicine. We all do some brief teaching on preventative care, but it's not our primary goal, and it's not what I'm interested in doing. Very different personalities.

Public health is not just health education, but a really broad field that looks at the health of populations and the systems that affect it.

Every EM encounter is affected by public health efforts or failings. EM should be a lot more active in public health and policy matters. Not teaching nutrition or whatnot in the ED, but making sure that it's happening elsewhere so it does not need to happen in the ED. The pathology behind many ED visits, in my experience, is bigger than what happens in the patient. That's why I think it's an important link.

If I were going to be a surgeon doing hernia repairs, I would need to know the mechanism, what precipitates them. Similiarly, in the ED if I'm going to see gunshot wounds, or overdoses, I want to know what went awry and maybe do something about it. If your ED sees a lot of children thrown from the backs of pickup trucks, maybe it would be more worthwhile to work for legislation banning passengers in the backs of trucks than waiting for the next kid to fly. It's not for everybody, I understand, but it's important for the specialty and to our patients.

 

[Sessamoid]

Every EM encounter is affected by public health efforts or failings. EM should be a lot more active in public health and policy matters.

Practically all physician-patient encounters are affected by public health concerns. I still contend that EM, as most of us practice it, would not be affected by the acquisition of an MPH degree. EM (and most of medicine) is a reactionary field, while public health is a proactive and preventative field, which tend to draw very different personalities. You were "surprised" and "shocked" that the first two posters (including the fellow probably going to get an MPH) would doubt that public health degrees would have a significant impact on their practice (which is how I read their posts). I don't see why. While the link is there, the effect on the daily practice of EM is not obvious. I disagree that we as EPs should play a large role in public health. That's why I think we have specialists in public health. I do think that there should be clear lines of communication between the two specialists, as we are the first sign of the failings in the public health system, but that doesn't mean that we should be doing their jobs.

Your example with the surgeon and hernias is apt. Sure, it's important for the surgeon to understand the mechanism of injury, but working on a nationwide or regional scale to reduce them is not his job. I don't see my surgical colleagues going to Gold's Gym weekly to talk to the powerlifters on the proper breathing techniques to minimize risk. I don't think that's their place.

I have a fair understanding of why gunshots and outbreaks of shigella happen (and we had one recently here). I also have some background in public health policy from my previous career, though somewhat indirectly. However, I don't really think it's my job to tour the restaurants, day care centers, or crack houses to prevent them. Our ED and lab report the appropriate diseases and injuries by protocol (as we should) and the public health guys take it from there. It doesn't really affect how I treat those patients on an individual basis. If you want to consider "emergency medicine" to encompass that kind of work, then you have a different definition of the field than I do.

 

[gimmedog]

Originally posted by gimmedog
It's not for everybody, I understand, but it's important for the specialty and to our patients.

This is a friendly discussion for the benefit of Hawaiibruin and others who may be considering getting an MPH, right? We can support different points of view. No one advocated EPs canvassing neighborhoods to do health education.

 

[FoughtFyr]

Originally posted by Sessamoid While the link is there, the effect on the daily practice of EM is not obvious. I disagree that we as EPs should play a large role in public health. That's why I think we have specialists in public health. [/B]

As a "specailist in public health", you could not be more wrong. More than any other specailty EM is DIRECTLY invovled in public health. For example, any illness/injury prevention program is catagorized into one of three types - primary prevention (keep it from happening), secondary (keep the problem from getting worse) and tertiary (keep it from happening a second time). All of EM is secondary prevention. This is different from other parts of medicine in that we treat all of a patient's illness/injuries (or at least coordinate their care), as oppposed to the orthopod who doesn't even notice the HTN in the hip repair pt.

This is only one example. County ERs as the "safety net" medical care for the impoverished, all occupational injury care, toxicology and EMS are but a few more "public health" duties of EM.

If you want, read the IOM report on "Public Health and Medicine", not only is this overlap well described, but EM is singled out as "public health". As such, many states place the coordination of trauma registries and trauma center designations (and licensure of EMTs, MICNs, and ambulance services) under their state's department of public health.

To the OP - as an MPH (before med school) and an M4 going into the match, my advice is this - if you care about the aspects of public health you have already discovered on your own - then go for the MPH. I have found the knowledge I gained from the degree very valuable during medical school. BTW - I hold an MPH from the UIC School of Public Health from the Department of Environmental and Occupational Health Sciences. When I took my coursework, all of the Occupational Medicine Residents from Cook County Hospital were required to complete the same program. Many of our instructors were EM physicians as there is a great deal of overlap in the areas of occupational medicine and EM as well as the obvious link to environmental toxicology.

Just my $0.02 (actual cash value $0.005)

- H

 

[Sessamoid]

Originally posted by FoughtFyr
For example, any illness/injury prevention program is catagorized into one of three types - primary prevention (keep it from happening), secondary (keep the problem from getting worse) and tertiary (keep it from happening a second time). All of EM is secondary prevention.

So you're classifying all of EM as a subspecialty of public health? Well, if you define it that way then sure there's a link. I don't disagree with your definition (it's your field, define it how you want), but how does getting an MPH affect my daily private practice of emergency medicine? Re: your fracture example. I learned how to stabilize and treat fractures in residency. What does having an MPH allow me to do in the ED that I haven't already learned?

This is only one example. County ERs as the "safety net" medical care for the impoverished, all occupational injury care, toxicology and EMS are but a few more "public health" duties of EM.

Thank you. I work in one. I know we're the safety net. I get that reinforced every day. Again, what I don't see is how the extra degree would change my private practice, which is really part of what the original poster asked about.

Many of our instructors were EM physicians as there is a great deal of overlap in the areas of occupational medicine and EM as well as the obvious link to environmental toxicology.

Exactly, and this is what I mean when I say that we need to keep the lines of communication open between EM and PH. Since PH deals with these things in the "bigger picture" I think those lines of communication are best initiated and managed by PH experts.

We should serve as an adjuctive role in public health, along with occupational health docs, trauma surgeons, hospital administrators, etc. I'm not arguing (as you seem to think) that there's no value to public health, or that the OP shouldn't get that MPH. It can make an interesting addition to a career in EM if you have that interest, but I don't see how it would affect my daily practice. Perhaps you can enlighten me?

 

[FoughtFyr]

Originally posted by Sessamoid
It can make an interesting addition to a career in EM if you have that interest, but I don't see how it would affect my daily practice. Perhaps you can enlighten me?

There is a great article on this very issue you can find at: http://www.dcmsonline.org/jax-medicine/1998journals/june1998/cookro.htm

I know that you realize (as do I) that an MPH is going to be no better at clinical skills, as applied to an individual, than a physician without the degree. However, I believe that the difference comes in the approach often taken by MPH trained docs in their practice.

Another difference was "defined" by a professor of mine (an MD/MPH) - "Physicians know medicine, and speak in medical terms and language. They see the world in terms of those things necessary to meet the individual needs of their patients. Community leaders speak the language of politics and see the world in terms of those things needed to meet the desires (or needs) of as many in their community as possible. MPHs are often translators between the two."

As for your daily practice, you do use public health in a myriad of ways. Any "evidence based medicine" is based on population studies - de facto public health.

I do not think you were attacking MPH holders. I just don't think the line is as clear between public health professionals and physicians. I believe the line to be very blurry, and personally I think it is most blurry in the ED. BUT, that is just my opinion.

- H