Physician to MPH

[BadHorse]

I need some advice. I'm thinking of getting an MPH, but I don't know if my reasoning is sound and I don't have enough information about what I'm thinking of getting myself into. This one's a little long, I apologize for that, but if you've got any insight into this I'd really appreciate it.



Alright, down the rabbit hole--

I'm an attending physician who has been getting more and more frustrated with the state of medicine and I'm trying to figure out how best to help the system and stay sane myself.

After bouncing along trying to get involved and find my outlet through various methods (getting involved in my hospital policies and committees, teaching residents/medical students, performing research, publishing in the lay press, leading international outreach programs) this thirst has not been slaked.

My chief frustration lies in the poor quality of medical research and the prevailing influence of pharmaceutical companies and device manufacturers at all levels of medical research publication and medical policy making. I am frustrated when treatments I believe are based in shoddy research with clear bias becomes standard of care, forcing me to offer treatments to my patients that I believe are at best unproven and at worst dangerous.

I don't know how to fix this. I know there is a core of brilliant academicians and skeptics who foster this same opinion, but they are poorly organized and, while many fight the good fight in important ways working at CMS or on the boards of medical journals I can't imagine going that route myself.

I think what I want is to compile a thesis about this issue. I think it would be cathartic, and maybe could do some good if it could be published and maybe turned into a book down the line. That's how I became interested in the MPH. My theory is that it would firm up my understanding overall of the health system I am trying to affect and give me access to people in the field that could potentially be compatriots and help me figure out where to go with my ideas.


I've thought about other degrees,such as an MPP, or a clinical fellowship in public policy, but I'm not interested in getting into government or getting involved in writing policy really. I like the idea of entering the realm of public health academics and possibly lecturing on my areas of interest once I've thoroughly explored and gained a modicum of expertise.

Does this seem like a valid course to achieve my goals? Have you heard of anyone doing something similar? Any alternative suggestions? I'm really open to any advice or critiques.

---

Members don't see this ad.

 

[LookForZebras]

I think this is a valid course to achieve your goals. However, I think you could also achieve your goals on your own if you're highly motivated to seek out resources to educate yourself and use your network to form new relationships with people who can assist you in thinking through ideas, pointing you in the right direction, etc. This second route would save money, but not necessarily a lot of time. A big consideration should be how structured you want this endeavor to be. Best of luck!

 

[BadHorse]

I think this is a valid course to achieve your goals. However, I think you could also achieve your goals on your own if you're highly motivated to seek out resources to educate yourself and use your network to form new relationships with people who can assist you in thinking through ideas, pointing you in the right direction, etc. This second route would save money, but not necessarily a lot of time. A big consideration should be how structured you want this endeavor to be. Best of luck!

Thanks for the response!

 

[Gringoperdido]

Most MPH programs are pretty flexible - you could probably find one where you'd be able to focus on evidence based medicine and education.
You might also consider a preventive medicine residency. They are 2 years and a MPH is part of the training. You also get practical training and experience that really augments the MPH. It's pretty common for people who are already residency trained to go back and do a PM residency as if it's a fellowship.

 

[BadHorse]

Most MPH programs are pretty flexible - you could probably find one where you'd be able to focus on evidence based medicine and education.
You might also consider a preventive medicine residency. They are 2 years and a MPH is part of the training. You also get practical training and experience that really augments the MPH. It's pretty common for people who are already residency trained to go back and do a PM residency as if it's a fellowship.

That's an interesting option, going through some of these programs they sound really interesting. I worry, though, that I wouldn't be able to do a residency like this and still continue practicing in my field (emergency medicine) and that my skills would atrophy.

 

[armchair_cosmonaut]

That's an interesting option, going through some of these programs they sound really interesting. I worry, though, that I wouldn't be able to do a residency like this and still continue practicing in my field (emergency medicine) and that my skills would atrophy.

I can't contribute anything to this discussion... but every time I see your username, the "Bad Horse" song from Dr. Horrible's Sing-Along Blog starts playing in my head.

he rides across the nation, the thoroughbred of sin
he got the application that you just sent in!
it needs evaluation, so let the games begin.....

or, the best part:

bad horse, bad horse, bad horse, he's bad!

 

[MazKanata]

That's an interesting option, going through some of these programs they sound really interesting. I worry, though, that I wouldn't be able to do a residency like this and still continue practicing in my field (emergency medicine) and that my skills would atrophy.

There are people who continue practicing emergency medicine while also completing medical research and being on the faculty of a public health school or even being the dean of a public health school. I think that these are folks who have strong research interests and a strong track record of public health related research in the ED, like smoking cessation programs in the ED, (maybe short interventions that can be impactful) and stroke prevention or secondary prevention in the ED. Emergency departments can become public health laboratories, so look for public health schools that have this sort of angle.

Also consider that you might have a little bit of burnout as you didn't seem to enjoy a range of activities "getting involved in my hospital policies and committees, teaching residents/medical students, performing research, publishing in the lay press, leading international outreach programs". EDs are becoming busier and busier, and there are a lot of social problems and non-emergency stuff. It might be possible to work just 2 shift a week in an ED and then work on an MPH on the side, and the preventive medicine residency isn't like a regular residency, it is for people who aren't going to see patients, so you maybe you could continue with working 1-2 shifts on the weekend or something, or even count a shift as part of the preventive medicine residency if it allows you to do research.

Yes, the people who continue to practice EM as well as engage in public health say they feel lucky that they are allowed to do so given the "skills atrophy" comments, though if you continue doing 1-2 shifts per week and also are engaged in related public health work it might make you a better clinician in the end.

With regards to changing current medical practice, yes, there are practices which aren't evidence based but continue on due to historical inertia, the only they change is if there are studies showing that a given practice is NOT clinically effective, or even harmful, and should be abandoned. These studies aren't what get clinicians excited about in the literature, people are always looking for a new treatment or something, but they are just as impactful, thought it takes time for abandoning a given practice to become standard practice in itself, but it does happen. In most grand rounds and articles in prestigious and respected journals, there is a disclaimer about conflicts of interests and such. But yes, pharmaceuticals pay for a good amount of certain types of research you might see in an ED, but also there is academic research just focused on evaluating different treatment options. There is a lot of pure public health research happening in EDs and this is an active area of interest and probably will benefit the productivity of EDs going forward.

Here is an interesting article:

The emergency department—a laboratory for public health

Charles, a longtime smoker and drinker, once had a job delivering pizzas. After the pizza place closed, he lost the job and started to drink more heavily.

medicine.yale.edu

It seems a lot of EDs have niche programs such as heavily targeting social services and outpatient medical care at the "super utilizers" which everybody in the ED knows as they come in every week for a span of time, or every month. EDs are very focused, and very good at, looking at the individual patient, triaging them, ordering tests and addressing high-level acuity stuff quickly, but at the population level, there is stuff that could be addressed to ease the work in the ED, even make the work more effective for the patient such as addressing and referring for drug and alcohol abuse more effectively and such, with the opioid epidemic, there is probably interest/funding to address that particular topic in relation to ED care as well.